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Doctoral Dissertations Graduate School

1-1-2010

A QUALITATIVE STUDY OF THE PERCEIVED HEALTH BENEFITS OF A THERAPEUTIC RIDING PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS
Margaret Ann Stickney
University of Kentucky, stix7074@aol.com

Recommended Citation
Stickney, Margaret Ann, "A QUALITATIVE STUDY OF THE PERCEIVED HEALTH BENEFITS OF A THERAPEUTIC RIDING PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS" (2010). Doctoral Dissertations. Paper 40. http://uknowledge.uky.edu/gradschool_diss/40

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ABSTRACT OF DISSERTATION

Margaret Ann Stickney

The Graduate School University of Kentucky 2010

A QUALITATIVE STUDY OF THE PERCEIVED HEALTH BENEFITS OF A THERAPEUTIC RIDING PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

________________________________________________ ABSTRACT OF DISSERTATION ________________________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Education in the College of Education at the University of Kentucky By Margaret Ann Stickney Lexington, Kentucky Co- Directors: Dr. Richard Riggs, Professor of Kinesiology and Health Promotion and Dr. Julie Cerel, Professor Social Work Lexington, Kentucky 2010 Copyright © Margaret Ann Stickney 2010

ABSTRACT OF DISSERTATION

A QUALITATIVE STUDY OF THE PERCEIVED HEALTH BENEFITS OF A THERAPEUTIC RIDING PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

Therapeutic horseback riding can be recommended as a useful health promotion intervention for individuals with disabilities who face challenges to optimal health and wellness. This qualitative study examined the perceived benefits of a therapeutic riding program for children with autism spectrum disorders (ASD), with particular focus on aspects that can potentially help maximize the physical, emotional, and social health of this population. This study utilized multiple methods to gain an in-depth perspective on the benefits of a therapeutic riding program based at Central Kentucky Riding for Hope in Lexington, Kentucky, for subjects presenting primarily with ASD. Focus groups were held with five instructors and five class volunteers, and semi-structured personal interviews were conducted with two staff members and the parents and family members of 15 children diagnosed with ASD who were currently enrolled a riding session. Client records containing medical history, lesson plans and client evaluations were also reviewed. Thematic analysis of the data supported perceived gains in the areas of physical, cognitive, psychological, and social development and also highlighted additional support mechanisms for family members of the clients. Some of the most common benefits reported included increased physicality, improved focus and attention, modification of inappropriate behaviors, enhanced self-concept, and increased social interaction and communication. Major factors believed to affect the success of this intervention were the unique movement and sensory stimulation of the horse, the supportive environment of the facility, and the increased motivation for the children to participate and complete the structured activities and exercises required in the riding class setting.

Results of this study encourage the utilization of therapeutic riding as an effective health promotion intervention for individuals with ASD. Recommendations for future research efforts include analysis of the effects of deep sensory pressure and the movement provided by the horse on the emotional regulation and cognitive processing of children with ASD. Study designs isolating the variable of the horse’s presence could further clarify the nature of the animal’s role in similar interventions. Quantitative studies with larger samples measuring specific cognitive, psychological, and social variables not previously studied but revealed in this data are also encouraged.

KEYWORDS: Autism, Autism Spectrum Disorders, Therapeutic Riding, EquineAssisted Therapy, Equine-Assisted Activity

________________________________________ Student’s Signature _________________________________________ Date

A QUALITATIVE STUDY OF THE PERCEIVED HEALTH BENEFITS OF A THERAPEUTIC RIDING PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

By Margaret Ann Stickney

____________________________________ Co-Director of Dissertation ____________________________________ Co-Director of Dissertation ____________________________________ Director of Graduate Studies ____________________________________ Date

A library that borrows this dissertation for use by its patrons is expected to secure the signature of each user. Bibliographical references may be noted. Name Date . but are to be used only with due regard to the rights of the authors. Extensive copying or publication of the dissertation in whole or in part also requires the consent of the Dean of the Graduate School of the University of Kentucky. but quotations or summaries of parts may be published only with the permission of the author.RULES FOR THE USE OF DISSERTATIONS Unpublished dissertations submitted for the Doctor’s degree and deposited in the University of Kentucky Library are as a rule open for inspection. and with the usual scholarly acknowledgments.

DISSERTATION Margaret Ann Stickney The Graduate School University of Kentucky 2010 .

Kentucky Copyright © Margaret Ann Stickney 2010 .A QUALITATIVE STUDY OF THE PERCEIVED HEALTH BENEFITS OF A THERAPEUTIC RIDING PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS ____________________________________________________ DISSERTATION ____________________________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of doctor of Education in the College of Education at the University of Kentucky By Margaret Ann Stickney Lexington. Richard Riggs. Assistant Professor of Social Work Lexington. Julie Cerel. Professor of Kinesiology and Health Promotion and Dr. Kentucky Co-Directors: Dr.

DEDICATION To my mom. who could not have loved and supported me more .

volunteered to serve on my committee and was always on hand to provide sound practical advice and unwavering support. her constant encouragement. In particular. Roberta Dwyer. Dr. staff and volunteers of Central Kentucky Riding for Hope who welcomed me most graciously into their facility. to my amazing friend Dr. Dr. long regarded as a friend and valuable resource during my career as an equine educator. I was honored to witness firsthand the knowledge. Committee members Dr. for steering me into a workable qualitative research approach. Executive Director Pat Kline and Program Director Denise Spittler cheerfully accommodated my every request throughout the data collection process and beyond. Secondly. Lisa Ruble. who patiently stood by me through my long graduate career and my many false starts. Two former committee members and professors during my coursework deserve credit for helping me out of the starting blocks: Dr. I would also like to thank the board of directors. I couldn’t have done it without her. Dr. Richard Riggs. and endlessly creative iii . and her willingness to answer a million questions along the way was essential in breaking the inertia and moving me forward through the process. Jody Clasey. always encouraging and always user-friendly. First and foremost to my committee chair. positive energy. Julie Cerel. Kim Miller. contributed her expertise in autism spectrum disorders. Her expertise in qualitative research. and my outside reader.ACKNOWLEDGMENTS The long hard road to completion of this degree is lined with supporters to whom I am most grateful. and Dr. whose innocent offer of assistance after a tennis match eventually led to her position as committee co-chair. Melody Noland and Dr. for initially suggesting a research focus on therapeutic riding. Melinda Ickes were careful to keep my research efforts grounded in a health promotion approach.

” who provided a most unique combination of support. I must also acknowledge the comforting presence of my three cats .who helpfully stationed themselves right at the computer all those many. And lastly. many hours. I could not ask for more loyal cheerleaders to gently prod me on to bigger and better accomplishments over the years. and co-workers who have patiently listened to the stories of my struggles while consistently reminding me of their collective belief in my ability to finish. encouragement.strategies that produce little miracles within their clients each and every day. An especially big round of applause goes out to all my wonderful family members. I love you all so much! iv . and Hambone . and music-to-work-by on a daily basis throughout this past year. And of course my research was chiefly inspired by the parents and family members of the therapeutic riding clients who willingly shared their poignant stories with me. providing insight into their special challenges and proactive efforts to help their children “be all they can be” – an inspirational message for us all. friends. Chester.Hank. a very special thanks to my “wingman.

..9 Goals of therapy…………………………………………………………....…………………...17 Summary of Research on Benefits of Mounted Equine-Assisted Therapy…….16 Psychosocial benefits of mounted equine-assisted therapy….TABLE OF CONTENTS Acknowledgments………………………………………………………………………...……………...13 Mounted Equine-Assisted therapy: Therapeutic Riding and Hippotherapy……..8 Chapter Two: Review of the Literature…………………………………………………..9 Autism Spectrum Disorders……………….9 Etiology and symptoms presented……………………………………….......12 Equine-Assisted Activity and Therapy.5 Limitations……………………………………………………………………….....15 Physical benefits of mounted equine-assisted therapy…………………..iii Chapter One: Introduction Background……………………………………………………………………….24 Summary…………………………………………………………………………29 Chapter Three: Procedures.20 Research of physical benefits of mounted equine-assisted therapy…….5 Definitions…………………………………………………………………………6 Summary…………………………………………………………………………..4 Research Questions……………………………………………………………..20 Research of psychosocial benefits of mounted equine-assisted therapy......3 Purpose of the Study.………………………………………...30 v .1 Statement of the Problem………………………………………………………….…………………………....…………………………………….……………………………………………………………30 Methods………………………………………………………………………….…………..

182 Summary………………………………………………………………………....42 Participants…………………………………………………………………. and Recommendations……...35 Analysis plan……………………………………………………………..43 Physical benefits…………………………………………………………63 Social benefits……………………………………………………………86 Psychological benefits…………………………………………………..258 Discussion………………………………………………………………………269 Recommendations………………………………………………………………276 vi .........30 Design and procedure..226 Summary……………………………………………………………………….238 Psychological benefits………………………………………………….. Conclusions.………………………………………………….234 Social benefits………………………………………………………….………………………………………………………………....42 Results……………………………………………………………………………43 Cognitive benefits…………………………………………………..Subjects………………………………………………………………..........39 Summary…………………………………………………………………………40 Chapter Four: Results..227 Conclusions……………………………………………………………………....…. Discussion..248 Family benefits…………………………………………………………..129 Family benefits………………………………………………………….229 Cognitive benefits………………………………………………………229 Physical benefits………………………………………………………...223 Chapter Five: Summary..

.300 Appendix F: CKRH record forms……………………………….…………….279 Appendix B: Recruitment documents………………………………………….....327 vii .Appendices Appendix A: CKRH Therapeutic Riding Program Research Statement…….310 References………………………………………………………………………………321 Vita……………………………………………………………………………………..280 Appendix C: Consent forms……………………………………………………284 Appendix D: Sample questions for focus groups and personal interviews……296 Appendix E: Participant profiles……………………………………………….

2008).Chapter One Introduction Background There are many different ways to define disability. released in 1990. 2010). thus warranting consideration as a critical public health concern. 2008). An individual may be born with or later acquire limitations in physical or mental function. Disabilities can affect people in different degrees. but persons with disabilities share many of the same challenges to optimal health and wellness. which influence to some extent that person’s ability to engage in activities of daily life. According to census bureau data for the year 2005. There is always a need for enjoyable and motivational therapies that can provide benefits for a range of disabilities such as therapeutic horseback riding.4 million (18. even within the same condition. caused by one or more medical conditions. approximately 54. 2008) and 35 million (12%) had a severe disability. and the opportunity to perform in specific contexts (Ninivaggi. Disability creates major economic and social impacts in the workplace and the country’s health care system. a general term that denotes significant functional problems in the capacity. Healthy People 2000 (United States Department of Health and Human Services. The three main goals for all priority areas were to increase quality 1 . was a federal initiative that identified the most significant preventable threats to health and served as a guideline for both public and private sector efforts to address those threats. the ability.7%) of individuals living in the United States were affected by at least one disability (United States Census Bureau. (Centers for Disease Control. which is often recommended as a useful community-based intervention for a number of physical and mental disabilities.

including for the first time. the national prevalence rate for children with a disability aged five to 15 years was 5. however. well-being. and set measurable objectives for disease prevention and health promotion in 28 focus areas.and years of healthy life. and are one of the most common types of impairment for children (Centers for Disease Control. reduce health disparities. 2008). Developmental disabilities encompass a group of conditions caused by mental and/or physical impairments that occur any time between birth and age 22. and eliminating disparities between people with and without disabilities in the United States population.1 percent (Cornell University. Healthy People 2010 (United States Department of Health and Human Services. The overview for this section describes a common misconception that people with disabilities automatically have poor health. and participation in life activities are relevant to all persons with disabilities. This perspective may have resulted in a lack of focus on health promotion and disease prevention activities for this population. pledged to eliminate health disparities among different segments of the population. Objectives for this area include promoting the health of people with disabilities. a condition 2 . In 2008. Many interventions that target optimal health. 2010) also sought to increase quality and years of healthy life. Disability and Secondary Conditions. Noting an increase in disability rates among youth. Healthy People 2010 illustrates the particular importance of providing appropriate health promotion and prevention of secondary conditions for this age group. preventing secondary conditions. This group includes ASD. Ten years later. 2008). and achieve access to preventive services for all Americans. with the ultimate objective of achieving and sustaining a level of physical and mental wellness that encourages a fullness of life.

as well as social skills training and psychotherapy. Statement of the Problem Horseback riding is considered by most to be merely a recreational or sporting activity. family life. Emotional distress caused by environmental barriers that limit children’s ability to participate in life activities can contribute to a decline in both physical and mental health. but increasing numbers of riding centers devoted to the therapeutic value of this activity speak to the long-held belief that greater benefits may be reaped from the almost mystical attraction horses have always held for man. family. 2010) are developmental disabilities such as ASD. Treatments commonly utilized for developmental disabilities such as ASD include physical. and intellectual disability. educational. and social health status (Centers for Disease Control. that can predispose affected children to both increased health concerns and the susceptibility to develop secondary conditions (Centers for Disease Control. Equine-assisted therapy programs provide services to persons with a wide variety of both physical and emotional disabilities. Three of the most common conditions presented by the population of more than 42. Proponents of therapeutic riding are 3 . cerebral palsy. pharmacologic. Objectives should address factors that will help prepare the child for success in education. cognitive. 2008). This combination of factors necessitates a continuous need for appropriate programs within a community that can help maximize the children’s overall physical. speech and language. 2001).likely to continue indefinitely.000 riders who participate in programs accredited by the North American Riding for the Handicapped Association (NARHA. emotional. and complementary and alternative therapies. behavioral. nutritional. sensory integration. 2008). and the community (National Research Council.

self-confidence and self-efficacy to improved communication and social skills. has remained scarce and is primarily limited to studies of physical benefits for riders with cerebral palsy. rather than what could be captured with standardized instruments. which is reportedly becoming one of the largest populations served at the local therapeutic riding facility. Research support for these claims over the past two decades.quick to provide lists of potential benefits for persons with a range of disabilities. and severity of symptoms among subjects have often limited demonstration of consistent positive effects. however. and social health of this population. 4 . emotional. although even small improvements that traditional measurement tools might not be sensitive enough to detect can have major practical and psychological significance for participants and their families. Purpose of the Study The purpose of this qualitative study was to examine the perceived health benefits of a therapeutic riding program intervention for children with autism spectrum disorders. sex. Small sample size and heterogeneity due to variances in age. including physical gains such as decreased spasticity in muscles and improved balance and motor performance as well as psychosocial benefits ranging from increased selfesteem. Psychosocial benefits derived from therapeutic riding have received little research focus within any population. The qualitative design provided the researcher with a greater understanding of the particular experiences of the intervention that could potentially help maximize the physical. Only one peer-reviewed study was found regarding the effects of therapeutic riding for ASD.

if any. 5 . if any. Lists containing contact information for specific instructors and class volunteers were provided to the researcher by the Program Director based on her opinion that these individuals could offer the best experiential reflections due to their length of service with clients with ASD. Central Kentucky Riding for Hope. if any. and staff members? 2. program volunteers.Research Questions In order to achieve these goals. and staff members? 3. will be reported by instructors. What social benefits affecting overall health status of clients. parents. several research questions must be answered. program volunteers. These questions regarding the population of ASD clients that participate in one therapeutic riding program included: 1. and staff members? Limitations This study was limited by pre-selection of many participants by the therapeutic riding facility. Contact information for parents was also provided by the Program Director due to confidentiality issues. program volunteers. parents. will be reported by instructors. but all parents or primary caregivers of currently-enrolled therapeutic riding clients with autism spectrum disorders had given prior permission to be approached by the researcher. What physical benefits affecting overall health status of clients. parents. will be reported by instructors. What psychological benefits affecting overall health status of clients.

Developmental disabilities include a group of conditions caused by mental and/or physical impairments that occur any time between birth and age 22.. Vermeer. 2001). Unlike autistic disorder. Asperger syndrome. All of these related developmental disorders are marked by significant social. there are no significant delays in language. Rett’s disorder. M. J.Definitions Terms related to subject content presented in this study will be defined in this section. childhood disintegrative disorder. cognitive development. ranging from very mild to severe deficits. This term is utilized in this study as the most representative of the selected group of therapeutic riding program clients who are located at several different points in the range of clinical symptoms. van Petegem-van Beek. Autism spectrum disorders (ASD) is the more common term for pervasive developmental disorders (Murray. 2000). repetitive patterns of behavior. interests. P. causing impairment in movement and posture (Ketelaar. ‘t Hart. Willis. Ruble. Cerebral palsy is a condition characterized by a collection of nonprogressive but often changing motor disorders that result secondarily to abnormalities in the developing brain. including autism 6 . and activities. H.. Symptoms of ASD may appear at different ages and affect each individual in different ways. and pervasive developmental disorder not otherwise specified.. A. 2003). E. 2009) which include autistic disorder. M. & Molloy. or self-help skills (Sadock & Sadock. communication and behavioral challenges (American Psychiatric Association. Asperger’s disorder is a developmental disorder marked by impairment in social interaction and restricted. & Helders...

hippotherapy. Equine-assisted activity and therapy refers to a general category of interventions utilizing the presence of a horse. providing a continuous. Sidewalkers also 7 . childhood disintegrative disorder. Rett’s disorder.spectrum disorders. intellectual disabilities. and vision impairment. all of which are characterized by markedly abnormal or impaired social and communication skills and restricted activities and interests (American Psychiatric Association. occupational. Meltdown is a colloquial term commonly used to describe an extreme emotional upset or temper tantrum. including therapeutic riding. or speech therapist. 2000). Hippotherapy is an equine-assisted therapy in which the horse serves only as a treatment tool. and other nonmounted activities such as equine facilitated psychotherapy. hearing loss. Hippotherapy is considered a medical intervention and must be provided under the supervision of a licensed physical. Sidewalker is an assistant in mounted equine activities who walks or jogs alongside the mounted rider and helps to stabilize the rider through direct contact or by remaining vigilant in close proximity to help balance the rider if necessary. cerebral palsy. rhythmical motion with the client mounted on his back. Horse leader is an assistant in mounted equine activities who helps preserve the rider’s safety by controlling the horse through direct contact on a lead shank or rope attached to the horse’s halter or bridle. Pervasive developmental disorders (PDD) is a comprehensive term encompassing autistic disorder. Asperger’s syndrome. and pervasive developmental disorder-not otherwise specified.

or saddle pad. with the long term goal of independent riding. such as a halter.function as a liaison between instructor and rider by reinforcing both instructor commands and client compliance to instruction. but the general lack of research focusing on this type of equine-assisted therapy. and psychosocial skills of the rider and are designed to meet the individual needs of the rider. Therapeutic riding was also described as an intervention that offers many purported benefits to clients with ASD. bridle. Copyright © Margaret Ann Stickney 2010 8 . The purpose of the study was then explained and a list of the related research questions was provided. Concluding the chapter were definitions of terms that are relevant to topics in the study. cognitive. has resulted in a lack of scientific support for this potentially effective community intervention. Therapeutic riding is a type of mounted equine-assisted therapy that requires the rider to learn the basics of guiding and controlling his or her mount. which includes those children diagnoses with ASD. Tack refers to equipment used or worn by the horse. especially for this particular population. Summary This chapter introduced the health initiatives encouraged by the federal government’s Healthy People 2010 regarding youth with disabilities. saddle. Exercises and activities performed target the physical. if possible.

one of the most common diagnoses of clients in therapeutic riding programs. and therapeutic goals for autism spectrum disorders. Autism Spectrum Disorders Etiology and symptoms presented. and their purported physical and psychosocial benefits. Next is a brief history of equine-assisted therapy and its current applications.Chapter Two Review of the Literature The purpose of this qualitative study was to examine the perceived benefits of a therapeutic riding program intervention for children with ASD. Rett’s disorder. as well as the lack of focus on psychosocial variables. therapeutic riding and hippotherapy. lending credence to the need for the current study. The qualitative design provided the researcher with a greater understanding of the particular experiences of the intervention that could potentially help maximize the physical. followed by an in depth explanation of the two mounted equine therapies. This chapter begins with a detailed discussion on etiology. the comprehensive term pervasive developmental disorders (PDD) includes autistic disorder. emotional. childhood disintegrative disorder. and social health of this population. symptoms. Asperger’s syndrome. and pervasive developmental disorder – not otherwise specified (American Psychiatric 9 . Lastly. rather than what could be captured with standardized instruments. a review of peer-reviewed studies for both therapeutic riding and hippotherapy will demonstrate the dearth of research involving populations with disabilities other than cerebral palsy. As categorized by the Diagnostic and Statistical Manual IV–TR (DSM-IV-TR).

2000). out-of-context or repetitive phrases.Association. 2003). but often react strongly to any change in their environment or daily routine.” Children affected with autism spectrum disorders are typically unable to respond appropriately in a social environment and do not develop relationships with peers or share enjoyment. and often includes hallmarks such as echolalia. Leo Kanner (1943). but exhibiting stereotyped or repetitive patterns of behavior such as hand flapping. Problems with development of cognitive skills are common. interests or achievements with others. such as parents. Responses to sensory stimuli may vary from hypo to hypersensitivity. Verbal communication is impaired due to a lack or delay in spoken language as well as the inability to maintain a reciprocal conversation. and as many as 75% of those affected with autism spectrum disorders also exhibit mental retardation. and pronoun reversal (Sadock & Sadock. but the condition has probably existed throughout history. first identified it as a disorder of “autistic disturbances of affective control. avoiding eye contact and showing no awareness of the needs or emotions of others. The commonly-used term autism spectrum disorders (ASD) is utilized in this study to collectively describe these conditions which are all characterized by markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests that manifest in children before the age of three years. Affected children may have the intent to establish relationships but are prevented from doing so due to poor 10 . ranging from mild (30%) to profound (45-50%) impairment (Sadock & Sadock. The earliest published descriptions of autistic behavior stem from the 1800’s. Children display limited attachment behaviors and do not always acknowledge those persons closest to them. 2003). The child psychiatrist. The child with ASD classically appears oblivious to those around him.

comprehension of social behaviors and lack of skills such as joint attention, which is the ability to attend to multiple cues or to coordinate attention between people and objects (Ruble, 2001). Cognitive skills necessary to appreciate the concept of humor are usually absent. Interactive or spontaneous imaginative play is typically nonexistent, but impulsivity, hyperactivity, aggressiveness, mood swings, self-injury, and temper tantrums are quite common (American Psychiatric Association, 2000). Up to 25% of those people affected may also develop seizures. The DSM-IV-TR reports a median prevalence rate for autism spectrum disorders of 5 per 10,000 individuals, with reported rates from 2-20 per 10,000. Sadock and Sadock (2003) report a prevalence of 8 per 10,000 for autism spectrum disorders, with ranges of 2-30 per 10,000 reported. Kabot, Masi, and Segal (2003) describe one study defining rates as high as 1 per 250 individuals for ASD, with an average incidence in the literature of 1 per 500. The Centers for Disease Control’s Autism and Developmental Disabilities Monitoring Network released data in 2007 describing that 1 out of 150 eight year-olds in multiple areas of the United States were affected by ASD; the average is now reported to be 1 out of 110 (Centers for Disease Control, 2008). ASD affects all racial, ethnic and socioeconomic groups equally, but occurs 4-5 times more frequently in males. While noting an increase in prevalence statistics in recent years, the CDC questions whether this increase is an accurate reflection of more cases or a change in how symptoms are identified and classified. The cause of ASD remains unknown, although most researchers suspect a genetic susceptibility coupled with unidentified factors present in pre- or postnatal development that trigger symptoms (Kabot et al., 2003). There is a decided familial risk; if one child has autism spectrum disorders, the family has a 2-8% chance of having a second child

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affected (Centers for Disease Control, 2008). In identical twins, if one is affected, the other child has a 75% risk factor, while a non-identical twin has only a 3% risk (Centers for Disease Control, 2008). Goals of therapy. Autism spectrum disorders cause profound deficits in social reciprocity skills, which is the main source of impairment for those affected no matter what the level of cognitive or language abilities (Ruble, 2001; White, Keonig, & Scahill (2007), and this impairment does not improve simply with development. Children affected by autism spectrum disorders, especially adolescents, are often shunned by peers and lead relatively isolated lives (Sadock & Sadock, 2003), particularly as they become more aware of their disability. Problems with social interaction may lead to academic and occupational underachievement and lack of community inclusion, as well as mood and anxiety problems in later years (Ruble, 2001; White et al., 2007); therefore, social development in autism spectrum disorders is crucial for positive adult outcomes and optimal quality of life. Only a small percentage of those affected by autism spectrum disorders will go on to function as completely independent adults (American Psychiatric Association, 2000), although about one-third may achieve at least partial independence. Appropriate interventions for ASD should address social and daily living skills; language and communication; play and leisure skills; academic achievement; reduction of maladaptive behaviors; and optimization of medical care (Myers & Johnson, 2007). The structure of the therapy should work to improve attention, engagement, reciprocal interaction, and communication. The acquisition of organizational skills such as following directions and task completion coupled with the ability to respond to

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appropriate motivational strategies can help prepare the child for success in the classroom (National Research Council, 2001). As children with ASD may have more limited opportunities for peer interaction, training in a group format may be most ideal. Programs should encourage social motivation and foster self-awareness and self-esteem in a nurturing, enjoyable environment that intersperses new skill acquisition with prior-mastered skills while reinforcing positive behaviors (White et al., 2007). The primary goal of therapy is to maximize the child’s ultimate functional independence and quality of life while minimizing core features of autism spectrum disorders (Myers & Johnson, 2007). The lifelong goal (Kabot et al., 2003) is independence in home and community life. Although intervention and treatment is universally recommended at the earliest possible age once symptoms become apparent, there are few empirical studies to support any specific types of therapeutic programs (Kabot et al., 2003). Equine-Assisted Activity and Therapy The modern world first noted the capabilities of persons with disabilities to enjoy equine competition in 1952, when former polio victim Liz Hartel won a silver medal in the Helsinki Olympics (Bertoti, 1988; Casady & Nichols-Larsen, 2004; Kaiser, Spence, Lavergne, & Vanden Bosch, 2002;). The history of the concept of horse as healer, however, goes back to the ancient Greeks, when horseback riding was recommended to raise the spirits of the chronically ill (Benda, McGibbon, & Grant, 2003; Macauley & Gutierrez, 2004), or to the rehabilitation of Roman soldiers wounded in battle (Benda et al, 2003). German physicians recommended horseback riding for patients suffering from

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mental illness in the 1600’s (Benda et al., 2003; Frewin & Gardiner, 2005). Chassaigne undertook the first systematic, though subjective, study of the effects of riding upon hemiplegia, paraplegia, and other neurological disorders in the 1870’s (cited in Bertoti, 1988), noting improvements in balance, muscle strength, joint suppleness, and morale. Therapeutic riding became widely appreciated in Europe during the 1950’s and 1960’s, and arrived in North America in the late 1960’s and early 1970’s with the founding of therapeutic programs in Canada and the United States. There are now more than 800 accredited therapeutic riding facilities in North America (NARHA, 2010). As equine programs have expanded and diversified in the United States, so has the related vocabulary. The gold standard accreditation organization, the North American Riding for the Handicapped Association (NARHA), uses the term EquineAssisted Activity and Therapy (EAAT) to cover therapeutic riding, hippotherapy, and other non-mounted activities such as Equine Facilitated Psychotherapy (EFP). EFP utilizes the horse as an adjunct therapeutic tool for experiential psychotherapy, in the presence of a licensed therapist, for clients with “any significant variation in cognition, mood, judgment, insight, anxiety level, perception, social skills, communication, behavior, or learning” due to psychological disorders, environment, or major life changes, and “provides the client with opportunities to enhance self-awareness and repattern maladaptive behaviors” (NARHA, 2008). Another accreditation group, the Equine Growth and Learning Association (EAGALA), also promotes training for equine psychotherapy for emotional growth and learning, which they term Equine Assisted Psychotherapy (EAP).

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Mounted Equine-Assisted Therapy: Therapeutic Riding and Hippotherapy There are two types of equine therapy involving mounted work: hippotherapy and therapeutic riding. In hippotherapy, the horse serves only as a treatment tool, providing a continuous, rhythmical motion with the client on his back. The horse influences the rider rather than the rider influencing the horse. Hippotherapy is considered a medical intervention and must be provided by a physician or a licensed physical or occupational therapist, with the additional aid of horse leaders and sidewalkers to control the animal and support the rider. Benefits of hippotherapy include mobilization of the pelvis, spine, and hip joints; normalization of muscle tone and symmetry; strengthening of weak muscles; improvements in standing posture; stimulation of deep proprioception in joints; sensory integration; increased coordination; awareness of one’s body in space; and normalization of movement patterns (Hamill, Washington, & White, 2007). The main goal of hippotherapy is to modify a rider’s impairment through the use of a prescribed riding program (Haehl, Giuliani, & Lewis, 1999), and is especially effective for riders with impaired postural control and coordination, as well as speech and language deficits (Macauley & Gutierrez, 2004). The typical hippotherapy rider might have impairments that would prevent more active participation in a therapeutic riding class. Therapeutic riding, in contrast, utilizes the same types of exercises as hippotherapy, but also requires the rider to learn the basics of guiding and controlling his mount, with the long term goal of independent riding if possible (Hamill et al., 2007; Haehl et al., 1999). Therapeutic riding can be of real benefit to riders by promoting muscle relaxation, strengthening weak muscles, and developing balance and

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coordination. The rider maneuvers his mount around the riding ring, using hand and leg aids, demonstrating his ability to make the horse turn, stop, start, and change speeds or gait. Aided by the horse’s leader and the sidewalkers, the rider might go through a series of stretching exercises, be asked to ride with eyes closed to concentrate on balance, or throw and catch objects with the helpers at a variety of angles. In the typical group riding situation, games which incorporate physical skills with cognitive processes are often played during the session. These might involve relay races, obstacle courses, drill team formations, or any creative plan that fits the needs of the particular riders. Both hippotherapy and therapeutic riding can provide benefits for a large number of physical, cognitive, social, and emotional disabilities. There are similarities and dissimilarities between therapeutic riding and hippotherapy. However, the similarities in positive effects from very limited scientific studies warrant more research in both areas. The current study will focus on therapeutic riding only. Physical benefits of mounted equine-assisted therapy. The mere act of positioning a subject atop a mobile equine exacts a physical response. The walking gait of the horse is quite similar to the human walk, moving at a rate of 100-120 steps per minute compared to man’s 110-120 steps. In addition, the horse’s limb displacement and acceleration and deceleration through the stride causes the rider’s pelvis to tilt laterally and rotate anteriorly and posteriorly in a continuous pattern (Cherng, Liao, Leung, & Hwang, 2004; Hamill et al., 2007), thus allowing the mounted horse to serve as a therapeutic walking simulator. As the animal is asked to stop, start, turn, and alter tempo, the rider is constantly required to accommodate to the postural

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Riding provides training for the trunk in coordination. When a rider performs certain functional exercises such as reaching out for objects while aboard this unique physical therapy modality. Hamill et al. 2003.. and reaction time. balance. 2004). 2004.. he or she can work to create increased body awareness. smell. 2004).. Although potential physical benefits derived from therapeutic riding and hippotherapy have traditionally received the greater focus. with constant alterations between muscle tension and relaxation that encourages development of adaptive behaviors and movement strategies on a dynamic surface (Casady & Nichols-Larsen. affecting motor. 2007). rhythmic movement of the horse as well as its warmth. 2004). appearance. Since the development of postural control is crucial to normal gross motor activities (Cherng et al. tactile. cognitive.. The consistent. as well as improved respiratory and motor control of speech (Macauley & Gutierrez. extension and rotation (Hamill et al.. and vestibular systems (Benda et al. The relatively recent development of equine facilitated psychotherapy is predicated on these 17 . 2004) that are necessary for development of motor control (Cherng et al.changes in order to stay aboard by producing compensatory movements to reduce displacement of the center of gravity (Casady & Nichols-Larsen. 2004). those involved with such programs have also delineated many social. horseback riding could affect the successful acquisition of motor skills in other functional tasks. balance. 2007). 2004). visual. and joint flexion. Casady & Nichols-Larsen. and furry coat sends an array of sensory signals to the central nervous system. Psychological and social benefits of mounted equine-assisted therapy. proprioceptive. and emotional effects. The walking horse provides up to 100 impulses per minute in which to practice both anticipatory and reactive postural control (Casady & Nichols-Larsen.

types of potential benefits. thus providing relaxation and recreation as well as the opportunity to develop personal responsibility and to learn about relationship-building (Kaiser et al. others would describe a common human desire to participate in sport and recreational activities that is often quite limited or totally denied to persons with disabilities.. 2003) that may be transferred to other endeavors. he will effectively mirror the human behaviors and emotions directed toward him and provide immediate feedback on his interpretations (Frewin & Gardiner. empathy. Mackinnon. Laliberte. respect. (2003) describe the significance of the “psychological 18 . 2005). 2004). He regards human advances as potentially threatening and can react very quickly with a classic flight response – running away from the perceived threat. Lariviere. The horse. McGibbon & Grant. 2003. Safe and successful interactions with this animal demand development of careful attention. 2003). Joy. but such gains have been commonly observed in riding activities as well. 1995). While some believe that man has an inherent desire for risk exercise that draws individuals to challenges such as horseback riding (Benda et al. & Allan.. The successful rider or handler must overcome any innate fear and present a calm. Although the horse initially plays a non-judgmental role in the human-equine partnership with few prior expectations or prejudices. concentration. unlike other animals typically used for therapeutic purposes. Taking on the challenge of remaining on top of such a large and powerful animal can result in increased self-confidence and a sense of mastery (Bizub. Success in riding is not an easy task for able bodied people.. The horse can serve as a buffer from stress and anxiety (Bizub et al. & Davidson. Benda et al. positive persona to the animal. Noh. and patience. is by nature a prey animal. 1998)..

and a sense of control. 2005). self-esteem. and provide a sense of well being. communication. and social interaction. behavior.. locus of control. self-concept. and affect (Macauley & Gutierrez. do more. 2003 is “learn more. Participation in a therapeutic riding class requires interaction not only with the horse. 2003) can provide positive social support and a sense of group cohesiveness. Clients must learn to take instruction and follow directions for mounted activities within their group. Successive mastery of riding skills can encourage increases in self-efficacy.enhancement of moving freely through space on a powerful animal without constraints or assistive devices” for those with limiting physical disabilities. and within their group. 2004). thus encouraging more positive compliance and interest in learning than they might exhibit in more traditional settings. but also with instructors and volunteers who serve as horse leaders or sidewalkers to help maintain rider safety. Children with disabilities who resent traditional therapies often find lasting motivation to participate in horse related activities. Positive experiences in therapeutic riding can lead to improved self-concept. be more. as described by Bizub et al.. and positive affect in turn encourages the brain to process sensory data more effectively and to release chemicals that help reduce stress. The most succinct psychosocial goal. encouraging focus. listening skills.” 19 . Therapeutic riding clients are encouraged to use interpretation and insight to develop successful strategies in working with horses (Frewin & Gardiner. relax muscles. Volunteers and classmates (Bizub et al.

and they might also still benefit from increased muscular strength and joint range of motion. leading the author to suggest that this therapy may actually be reinforcing abnormal compensatory mechanisms rather than encouraging a more normal postural response in the more severely affected riders. Most research has focused on the purported physical benefits of these two therapies. In 1998. however.Summary of Research on Benefits of Mounted Equine-Assisted Therapy Research on physical benefits of mounted equine-assisted therapy. MacPhail et al. Subjective clinical impressions such as decreased fear of movement. Bertoti (1988) assessed standing posture in 11 children with spastic CP in the first data-based study and found statistically significant improvement following a 10-week program of therapeutic riding. This therapy might not necessarily be detrimental for those individuals. decreased hypertonicity. Despite a plethora of anecdotal reports of the value of hippotherapy and therapeutic riding for clients representing a wide range of disabilities. and improved weight-bearing and functional balance were also noted by physical therapists and parents. videotaped and analyzed seven non-disabled riders and six riders with varying degrees of CP to determine if both groups would respond with normal equilibrium reactions in response to the displacement caused by the pelvic motion of the horse. there are relatively few peer-reviewed studies to support such claims. Results reported that riders with cerebral palsy had more trouble controlling trunk movements and maintaining their center of gravity over the base of support. Those riders with diplegic CP attempted to adjust their equilibrium reactions with greater success than those with quadriplegic CP. MacPhail’s kinematic analysis in this 1998 study demonstrated that the horse’s pelvic movement at a walk 20 . and most studies have focused on subjects diagnosed with CP.

Washington. MacKinnon. Although no statistically significant improvement was shown on the standardized measures. aged 27-54 months. pelvic mobility. In 2007. and gait were commonly noted from all sources. et al. trunk control.causes a more complicated pattern of displacement for the rider than previously thought. the qualitative measures consisting of the riding instructor’s journals. Weekly progress in areas such as mounted sitting position. (1995) were the first to utilize a number of both quantitative and qualitative tools to evaluate both physical and psychosocial effects of a once-weekly. thus requiring a more demanding postural response. however. balance. parental report sheets. and videotapes of the riding sessions indicated changes not noted in the quantitative measures. Hamill. The researchers believed these contrasts could be interpreted as self-fulfilling prophecies on the part of the parents and staff or the failure of available standardized tools to adequately measure change. Interestingly. Although improvements in physical abilities were shown in some of the quantitative tools measuring gross and fine motor control. Lariviere. aged 4-12 years. with mild to moderate CP. therapists’ final client summaries. Noh. despite the perceived effectiveness of the intervention. strength. grip and use of reins. the only statistically significant result occurred in the skill of grasping. six month long therapeutic riding program on 19 children. the questionnaires revealed perceived improvement in the 21 . & White collected similarly conflicting data including the standardized Gross Motor Function Measure (GMFM) and the Sitting Assessment Scale as well as a parental questionnaire to examine the effects of a 10-week hippotherapy session (one session per week) on sitting posture for three children with CP. The length of time necessary to demonstrate improvement in chronically disabled populations could also preclude measurable changes.

France. and remained elevated even six weeks following the program’s end. Similarly. There were no changes in WeeFIM scores during the study. researchers believed the discrepancy in results could reflect parental expectations for positive results. Once again. and cadence. The researchers also utilized the Children’s Functional Independence Measure (WeeFIM) to determine each rider’s level of independence in self-care. locomotion. gait dimensions of stride length. All five children showed a statistically significant decrease in walking energy expenditure. or improvement in motor function that the tools employed could not measure. (2003) found that participants who spent eight minutes on a hippotherapy horse demonstrated improved muscle symmetry compared to those who spend eight minutes sitting astride a barrel. (1998) used a repeated measures-within-participants design to evaluate the effects of an eight week hippotherapy program for five children with spastic CP on energy expenditure during walking. velocity. Many other riding therapy research teams have incorporated the GMFM into their studies. aged 4-12 years. sphincter control. Benda et al. and performance on the GMFM. during and after an 18-week therapeutic riding intervention. Sterba. and Vokes also used the GMFM to evaluate 17 children with spastic cerebral palsy at multiple six week intervals before. in 2002. Rogers. 22 . Utilizing electromyography to evaluate symmetry of trunk and upper leg muscle activity in 15 children with spastic cerebral palsy. communication.children’s trunk control and sitting posture. McGibbon et al. with a statistically significant increase in the Walking/Running/Jumping phase of the GMFM. and social cognition. transfer ability to and from a wheelchair. but scores in the GMFM began to increase significantly after Week 12 of riding. as well as appreciation for the overall value of the intervention.

mobility.suggesting that the movement of the horse was more effective than passive stretching activities. and social function. Although only one child demonstrated significant changes in functional mobility through the PEDI measures. Cherng et al. Casady & Nichols-Larsen (2004) employed both the GMFM and the Pediatric Evaluation of Disability Inventory (PEDI) as outcome measures to determine whether a 10-week hippotherapy intervention had an effect on the functional development of 10 children with CP. In 2004. Again. No significant changes in muscle tone were noted. and temporal phase relations for both novice and experienced riders. aged 3-12 years. Whereas the GMFM measures gross motor ability in a clinical setting. (1998) and Sterba et al. Results demonstrated a significant treatment effect through the PEDI total and social scores and the GMFM total score and crawling/kneeling score. Haehl. by the last riding session both children did adopt 23 . also used a repeated measures. showing the potential of hippotherapy to be a valuable treatment tool that maximizes function in a motivating setting. postural stability. who participated in a 16-week therapeutic riding program. within-participants design to assess potential gains in gross motor function and muscle tone of hip adductors for 14 children with spastic CP. (2002). Guiliani. mirroring the earlier work of McGibbon et al. & Lewis (1999) first analyzed the kinematic relationship between the rider’s trunk and the horse’s back to describe postural orientation. ages 2-6. the PEDI identifies functional performance in the home and community through functional skills. the authors reported significant results in the total GMFM score and the GMFM Dimension E (Walk/Run/Jump) score. They then examined the influence of 12 weekly hippotherapy sessions on postural control. coordination. and function for two children with CP.

Following a 10-week program carried out by the authors. who exhibited developmental delays due to various diagnoses.’s (1998) hippotherapy study. A greater shortage exists in the literature regarding assessment of the potential emotional. this study reported significant improvement in the GMFM scores. Sears. In contrast to MacKinnon. (2003). encouraging them to perform further studies on the duration of this effect. aged 4-7 years. 24 . Peters. walking ability and range of trunk rotation. Researchers found substantial decrease of muscle tone following 93% of the hippotherapy treatments. Hippotherapy was found to provide short term relief of spasticity in the lower extremities due to spinal cord injury in a study by Lechner et al. although gait speed was unaffected. & Winkley evaluated a seven-week therapeutic riding program to assess motor function and gait speed in seven children. an assessment demonstrated increased independent balance. Using a design similar to McGibbon et al. In this study. Kendall. moderate mental retardation and limited coordination of her trunk and neck. or social benefits resulting from mounted equine-assisted therapy. Research on psychosocial benefits of mounted equine-assisted therapy. (1998). cognitive. physical therapists rated the level of increased muscle tone through a series of joint flexion and extension movements prior to and immediately following a single hippotherapy session for 32 patients. Studies focusing on subjects with diagnosed conditions other than CP include Lehrman and Ross’s (2001) case study that described the benefits of a hippotherapy program for a 9 year-old with visual impairment. but comparable to McGibbon et al.the rhythmic biphasic movement patterns used by the experienced riders to balance successfully on the horse. in 2002 Winchester. (1995). aged 16-72 years. Lariviere et al. Noh.

Noh. 25 . the Harter Self-Perception Scale (completed by parents) to measure perceived adequacy in scholastic and athletic competence. aged 1115 years. willingness to try other new activities. self-esteem. Results from the paper-and-pencil Piers-Harris Children’s Self-Concept scale. cooperation. Younger riders showed more improvement. mental retardation. socialization. Cawley. and enthusiasm. Similarly. pride. and the Child Behaviour Checklist to evaluate social competence. Sterba et al. (1995) utilized the Vineland Adaptive Behavior Scales to assess self-adequacy. MacKinnon. who were identified by their school system as having special educational needs such as severe emotional handicap. leading the authors to recommend intervention at an earlier age. and parent surveys reported improvements in motivation. which measures the extent to which a student admits or denies problematic behavior. and behavior problems. Although these quantitative tools failed to confirm statistically significant improvements in these areas. Researchers noted that an interview format might have elicited more information from participants. and global behavior. showed a small increase in self-concept that was not statistically significant except for scores on the Behavior subtest. administered before and after an eight-week therapeutic riding program. social acceptance. physical appearance and behavioral conduct.Cawley. or learning disabilities. the qualitative measurements employed revealed conflicting results: Therapist records indicated progress in social interaction and confidence. self-confidence.. Lariviere et al. emotional adjustment. An analysis of video displaying the riders’ facial expressions during riding sessions also seemed to demonstrate increased levels of satisfaction and self-confidence. and Retter (1994) were among the earliest to focus on potential psychosocial benefits resulting from equine assisted therapy for 23 adolescents.

This population appears to be more at risk to experience negative emotional affect. Noting that 45. diagnosed with language-learning disabilities (LLD). listening. Macauley and Gutierrez (2004) examined the effectiveness of a hippotherapy intervention versus a traditional therapy program for three boys. and emotional well-being. found no significant improvements using the WeeFIM to measure changes in riders’ levels of communication and social cognition following a therapeutic riding program. and as many as 75% of children with LD’s also have LLD’s.(2002). which correlates with a decreased ability to respond to therapies that are deemed difficult or unpleasant. self-esteem. but informal surveys of parents reported observable improvements in their children’s speech. the authors stressed the need for innovative treatment environments that will motivate students to fully participate and work toward achieving their full potential. as well as a perceived high degree of enjoyment in the riding activity. which is more conducive to participation and compliance. Questionnaires completed by both the participants and their parents following each type of therapeutic intervention demonstrated equally effective self-reported gains in speech and language abilities and 26 .2% of the population with disabilities have co-existing learning disabilities (LD). Lehrman and Ross (2001) also described improved verbalization and an increase in visual attention span and fixation time for that case study’s nine year-old child with visual impairment and moderate mental retardation (MR). and language skills (including issuing commands to the horse) were considered influential in the significant improvement in PEDI social function scores by Casady & Nichols-Larsen (2004). ages 9-11 years. Besides improved physical measurements. The motivation and opportunities provided during a hippotherapy session to practice communication.

(2003) designed a qualitative study on the psychosocial effects of a 10-week therapeutic riding program for five adults with schizophrenic spectrum disorders who were undergoing psychiatric rehabilitation. Follow-up interviews 27 . Alternative therapies such as therapeutic riding can potentially help patients to acquire new interests. Bizub et al. often speaking with friends about this therapy experience. group identity. the opportunity to form a relationship and bond with the horse. and love for this initially-frightening large animal. Semistructured interviews were conducted with the participants following the intervention and again six months later. and experience decreased personal isolation. increased overall sense of well-being.progress toward therapy goals. develop self-efficacy. and above all. Riders enjoyed the physical contact and the experience of working as a team while developing respect. Themes identified from the transcribed material included the process of developing group cohesion. development of relationships with the volunteers who assisted in the program. which sets this type of intervention apart from all others. and social support among the riders. a normalizing experience. Goals for this population typically focus on facilitating and maximizing long term recovery. opportunities to practice coping skills. a greater sense of hope for the future. The horse was viewed as a non-judgmental source of support that helped diminish a sense of self-isolation.. self-sufficiency and community integration. the challenge of overcoming fear or riding and experiencing mastery that carried over into subsequent new activities. empathy. improved motivation to more actively participate in recovery and life in general. increased self-esteem and self-efficacy. the positive effects of exercise on relaxation and sleep. build social skills. but results also showed that the boys were clearly motivated to attend and participate in the enjoyable hippotherapy sessions.

Kaiser et al. Davis et al.months later further validated the significant impact of this program. health. which measures frustration. however. Utilizing quantitative measures of sensory processing as related to social function. physical aggression. Data analysis of the Children’s Inventory of Anger. directed attention. and social motivation. Although finding no significant increases in GMFM. in 2009 Bass. 28 . leading researchers to believe such an intervention could prove especially useful for at-risk populations. demonstrated significant decreases in total score and all subscales except frustration. decreased inattention and distractibility. or quality of life measures for subjects with cerebral palsy participating in a therapeutic riding program in 2008. significant results were noted in areas of sensory sensitivity and integration. The authors recommended analysis of the effects of therapeutic riding on the various aspects of social functioning following a longer. Duchowny and Llabre presented the results of the first study focusing on children with autism spectrum disorders participating in a 12-week therapeutic riding program. peer relationships and authority relations. (2002) presents the only study in the literature to examine psychosocial benefits in therapeutic riding for a non-disabled population of 16 children ages 7-17 who attended a five day riding camp. Three measurement tools were administered to the participants on the first and last day of the camp. The Peds Quality of Life scale and the Self Perception Profile for Children produced no significant changes.’s qualitative data from primary caregivers focusing on quality of life supported a recommendation for further research that would analyze the impact of that intervention on a child’s overall function. Finally. more intensive intervention.

Copyright © Margaret Ann Stickney 2010 29 . description of subjects. were introduced along with anecdotal reports of their physical and psychosocial benefits. including the design and procedure. symptoms. and therapeutic goals for autism spectrum disorders and gave a general history of equine-assisted therapy and its current applications. The next chapter will describe the methodology of the current study.Summary This chapter described the etiology. A literature review of published studies for both therapeutic riding and hippotherapy clearly demonstrated a lack of scholarly focus on the potential value of mounted equine therapy programs for participants diagnosed with autism spectrum disorders. The two common mounted equine therapies. therapeutic riding and hippotherapy. and the analysis plan for the data collected.

CKRH has been nationally accredited as a riding center since 1987 by the North American Riding for the Handicapped Association (NARHA). cognitive. including the selection process and description of the subjects. with a stated mission “to enrich the community by improving the quality of life and health of children and adults with special physical. The qualitative design provided the researcher with a greater understanding of the particular experiences of the intervention that could potentially help maximize the physical. and the analysis plan for the data collected. the gold standard organization in this field that conducts both 30 . rather than what could be captured with standardized instruments. Kentucky. CKRH has been in continuous operation since 1981. All subjects interviewed were a convenience sample.Chapter Three Procedures The purpose of this study was to examine the perceived benefits of a therapeutic riding program intervention for children with autism spectrum disorders. The research protocol was initially submitted to and approved by the University of Kentucky’s Institutional Review Board. 2010). This chapter will describe the methodology of the current study. as all were involved with the therapeutic riding program offered at Central Kentucky Riding for Hope (CKRH). the study design and procedure. emotional. a nonprofit corporation located at the Kentucky Horse Park in Lexington. emotional and social needs through therapeutic activities using the horse” (Central Kentucky Riding for Hope. Method Subjects. and social health of this population.

Prior to the start of data collection. In 1998 CKRH became certified by NARHA as a Premier Accredited Center.000 students with disabilities. Although the current study is limited to this facility. and coordination. riders may be accompanied by a horse leader and one or two sidewalkers for stability and safety. Both private and group lessons are offered. balance. dependent on the age and needs of the individual client. and safety in equine-assisted activities may allow for some generalization to other similar programs accredited by NARHA. the fact that the program and its instructors have met and must maintain established industry standards of quality. and the severity of the disability. Depending on their level of ability. CKRH therapeutic riding classes offer a variety of activities and exercises that target fine and gross motor skills. cognitive processing skills. with only minimal guidance from the horse leader or no leader at all. directed riding activities designed to enhance specific skills for guiding and controlling the horse at various speeds. many of whom have continued to ride at the facility for many years.facility and instructor certification for equine-assisted therapy programs. professionalism. proprioception and tactile senses. or they may ride more independently. a brief description of the research project was submitted to and reviewed by the CKRH board of directors (see Therapeutic Riding Research Project in Appendix). the level of riding skill. In 24 years of operation it has served over 1. 31 . and teamwork and social interaction. and a cool down period. group games such as treasure hunts or relay races. strength. Classes vary from 30-60 minutes in length and typically include a warm-up period during which the client is asked to perform stretching exercises while mounted. one of only two such accredited centers in Kentucky.

Five instructors agreed to take part in the discussion. and knowledge of disabilities and NARHA standards and guidelines. All five were certified by NARHA at the registered level. lesson planning and instructing abilities. One is the Lead Instructor and the other functions as both Program Director and class instructor. Although all eight instructors were willing to share their experiences with the researcher.Instructors. All NARHA-certified instructors must maintain annual CPR and specified continuing education requirements. CKRH also provides yearly instructor workshops on topics related to specific disabilities and strategies for working with clients. including three volunteer instructors (one male and two female) and two female staff instructors. Although the majority of CKRH instructors are volunteers. All other instructors contribute 32 . three had scheduling conflicts that precluded their participation in the scheduled focus group. The CKRH Program Director initially provided the researcher with a list of contact information for eight of the facility’s 12 therapeutic riding instructors who were recommended for inclusion in a focus group on the basis of their length of experience with the therapeutic riding program and their experience working with clients with autism spectrum disorders (ASD). CKRH has two paid instructors on staff. all are required to have completed the certification requirements of the North American Riding for the Handicapped Association. The investigator then contacted the eight instructors by e-mail or phone and invited them to attend a focus group session to be held at the CKRH facility. having successfully completed an instructor certification course requiring each individual to demonstrate horsemanship and riding skills.

sometimes accompanied the client to the lesson and 33 . All family members gave permission to be approached by the researcher. As consent forms (see Appendix C) were received from the listed contacts. A weekly class schedule for all 15 clients. Three of the instructors in the focus group had two to three years of experience at CKRH. Letters of recruitment (see Appendix B) containing consent forms and self-addressed stamped return envelopes were then mailed to each legal guardian on the contact list by the investigator. Parents and other family members. who reported to six separate CKRH instructors. Due to scheduling variations. To preserve client confidentiality. One parent had two children in the program. with prior teaching experience in other venues. such as grandparents. interviews were scheduled during each client’s lesson time during a three-week period of the fall 2008 CKRH riding session with 16 female and five male family members of the 15 children.their services as volunteers. the other two had 19 and 24 years experience in the program as instructors. family members other than the individual initially agreeing to participate. three were grandparents and one was the client’s aunt who was a primary caregiver. Seventeen of the subjects were parents. an initial e-mail communication was sent from the CKRH Program Director seeking permission from family members of 15 current clients diagnosed with autism spectrum disorders to be placed on a contact list for possible participation in the study. The researcher provided dinner for the subjects and also offered $25 gasoline cards as incentives for the instructors’ participation in the initial focus group. was provided to the researcher by the CKRH Program Director. who was then given a list with contact information.

and are strongly encouraged to attend continuing volunteer education and training opportunities provided by the facility. The Program Director. The CKRH Program Director initially explained the nature of the research project via an e-mail communication to a list of twelve of the program’s class volunteers who 34 . She has held this position at CKRH for five years. typically 8-10 weeks on length. CKRH maintains a staff of four full time and two part time employees. Volunteers are required to commit to serving at least two hours per week for consecutive weeks of a class session. and supervising the lead riding instructor and equine manager. such as sidewalker or horse leader. is responsible for all day to day activities of the therapeutic riding program such as scheduling of classes and instructors. She also serves as a class instructor. the female Executive Director and the female Program Director. A class lesson volunteer must be 17 years of age or older. The Executive Director’s duties are primarily administrative in nature. Profiles of the therapeutic riding participants themselves are located in Appendix E. must attend a volunteer orientation and a training session specific to their position. Staff members. signing the necessary consent forms on site. were recruited in person for semistructured interviews. Over 250 volunteers assist in the operation of the CKRH facility in a variety of capacities. The two staff members with the greatest length of experience with the program. who has held this position at CKRH for three years. Class volunteers. insuring the health and safety of the animals. with a great degree of contact with parents and caregivers of clients.agreed to be interviewed.

another e-mail was distributed to the list. and also offered $25 gasoline cards as incentives for the volunteers’ participation. asking for alternate scheduling preferences. it became necessary to hold two separate group meetings. Following the initial e-mail. The second focus group included one male with one year of CKRH class experience and one female with two years of experience. and analysis of the therapeutic riding program’s client records to gain an in-depth perspective on the perceived benefits of a therapeutic riding program for subjects with a primary diagnosis of autism spectrum disorders (ASD).were selected by the Program Director as potential participants based on length of time with the therapeutic riding program and experience during riding sessions with clients with autism spectrum disorders. Design and procedure. which elicited three more positive responses. hoping to have a total of 4-6 participants to keep the discussion manageable. and two female volunteers. The researcher provided a meal for both focus group sessions. Due to scheduling conflicts. This qualitative study utilized multiple methods including focus groups. 35 . semistructured personal interviews. the investigator contacted the 12 volunteers via e-mail and invited them to participate in a focus group to be held at the CKRH facility on a non-lesson evening. After initially receiving responses from only two volunteers. one with two years of experience as a class volunteer and the other with 23 years at CKRH. however. The first focus group included one male with 2 ½ years of experience in the CKRH program who volunteered from one to four evenings per week.

A research assistant also took written notes to assist in transcription of the audio recordings following the session. Semi-structured interviews with parents and family members. A list of guiding questions prepared by the researcher and approved by a committee co-chair that related directly to the research questions was utilized by the researcher in moderating the discussion (see Appendix D). All participants signed informed consent documents prior to the session (see Appendix C). which was audiotaped with the permission of all participants. As many of the instructors had several years of service in the program. and social benefits provided to their students and the multiple factors involved in this process.Instructor focus group. The research assistant had successfully completed the University of Kentucky’s Collaborative IRB Training Initiative (CITI) for non-medical researchers in human subject protection training prior to the event. a focus group was conducted at the CKRH facility on a non-lesson evening with three volunteer and two staff instructors from the therapeutic riding program with a meal provided by the researcher. This very interactive group session provided both an initial overview of the therapeutic riding program for populations with ASD and also a sampling of the instructors’ opinions on the perceived physical. The researcher served as a moderator in guiding the group discussion. After compilation of data from the instructor focus group and revision and approval by a committee co-chair of the initial list of guiding questions (see Appendix 36 . psychological. which was 90 minutes in length. Initially. their insights and observations for a large number of clients provided material for additions and revisions to the initially-proposed questions for the semi-structured interviews with client family members and CKRH staff.

which often led to additional topics not specified in the sample questions. The Executive Director and the Program Director of Central Kentucky Riding for Hope were also selected for personal interviews due to their collective observations of many different program participants with a diagnosis of ASD over a longer period of time than any other CKRH employees. Interviews with the two staff members were also held 37 . Although guiding questions were used. interviewees were encouraged to discuss what was most meaningful to them in their child’s experience at CKRH. telephone interviews were also conducted with those two children’s mothers at a later time. The on-site interviews were all held during the children’s lessons at CKRH over a three-week period and varied in length from 30-60 minutes.D). Interviews were held with a total of 21 parents or related caregivers of the 15 children. All interviews were audiotaped with the permission of the subjects. Semi-structured interviews with CKRH staff members. both the mother and father of the client were present for the interview. as many of the clients themselves have very limited communication capabilities. In the instances when grandparents of two of the children were interviewed on-site because they had transported the participants to CKRH. In two cases. These subjects were selected to provide in-depth descriptions of their children’s experiences and the perceived benefits derived from participation in the therapeutic riding program. This in turn resulted in the addition of new sample questions to the researcher’s list as the interviews proceeded. semi-structured personal interviews were conducted until saturation was reached and no new data were being presented by parents or other family members of children diagnosed with an ASD who were currently enrolled in the therapeutic riding session at CKRH.

Due to scheduling conflicts. With parental permission from the initial consent form. only an audiotape was used to record the discussion. but due to the smaller number of participants in the second group. and a list of sample questions (see Appendix D) relating back to all research questions and approved by a committee co-chair was used to guide discussion. specifically-listed records were made available by CKRH to the investigator (see Appendix F). CKRH class volunteer focus groups. These records included materials such as: annual application forms completed by a parent or legal 38 . Each interview was audiotaped with the permission of the participant. Three participants in the first group and two in the second signed consent forms (see Appendix C) prior to the interactive discussion. The Executive Director’s interview was 45 minutes in length and the Program Director’s lasted 60 minutes.in the offices of the riding facility and consent forms were signed prior to each session (see Appendix C). Each focus group lasted approximately 60 minutes and was audiotaped with the permission of all focus group participants. which was also held at the CKRH facility on a non-lesson evening with a meal provided by the researcher. The volunteers were asked to provide feedback on general comments solicited during the previous parent and family member interviews. using a list of sample questions (see Appendix C) approved by a committee co-chair and related to all research questions to guide discussion. The researcher served as the moderator in both group discussions. it was necessary to conduct two separate focus groups for class volunteers. A research assistant took notes for the first focus group. Review of CKRH client records.

which allowed the researcher an additional method of identifying consistencies within the data collected and contributed to the researcher’s overall understanding of the data. The Rider-at-a-Glance cards. or the use of multiple sources of information. Audio recordings from interviews were held in a locked enclosure and destroyed after they were transcribed. and problem areas to be targeted in therapy. warm-up exercises. All review of CKRH client files was done under the supervision of a CKRH staff member on the premises of the facility following completion of the focus groups and personal 39 . physician’s statements and detailed medical histories including diagnosis. evaluation reports from the client’s CKRH intake evaluation conducted by the CKRH Program Director. Each lesson plan details specific outcome objectives for the entire class. identified symptoms. instructor plans and session notes for each lesson that contain each lesson’s objectives and progress reports for the client. are generated with input from family members. which are made available to both instructors and class volunteers. non-confidential information regarding behavior management. and an evaluation for that individual client. activities and exercises. and Rider-at-a-Glance cards.guardian. Handling of data. Analysis plan. procedures. Records such as these provided validity and reliability to the study design through data source triangulation. and CKRH staff and contain abbreviated. Strict confidentiality was maintained concerning subjects and related data through assignment of fictitious names in all transcribed records. Clients are grouped as much as possible into classes of individuals with similar therapeutic goals. therapists.

comparison and recoding generated the combination of several sub-categories and the addition of two major areas. As data collection continued. Thematic analysis of focus groups and interviews. Spreadsheets were created for each major category and related sub-categories. Further examination of the data within each general thematic category resulted in the notation of many sub-categories for which quotations were labeled.interviews. All data created from the focus groups and the semi-structured interviews were transcribed verbatim as they were collected. Representative quotes that best illustrated and supported the constructs in each thematic classification were then selected for inclusion in the written results. CKRH client records. Rough counts of subjects offering supportive data for each thematic sub-category were recorded. 40 . psychological (yellow). Extensive notations were made during review of each client’s personal files. to the three initial a priori themes. and social benefits (green). the number of similar responses was noted in the results section to help identify the prevalence of major concepts presented by the data. Whenever possible. the process of analysis. cognitive and family benefits. Only the records specified on the parental consent forms were made available to the investigator. Transcript page numbers for appropriate quotations were recorded within each classification to aid in interpretation of the respondents’ comments. Quotations within the text were initially color-coded to denote the relationship to the three major categories described in the research questions involving physical (blue).

The next chapter will report in-depth results of the study regarding the perceived cognitive. psychological. semi-structured interviews with staff members and parents or other family members of the program’s clients diagnosed with autism spectrum disorders. social. physical. the design and procedure. and the method of handling and analyzing the collected data. and review of CKRH client records. Summary This chapter described the methodology of the current study. The research design utilized multiple methods including focus groups for both therapeutic riding program instructors and class volunteers.These data were utilized to create the participant profiles contained in Appendix E and served as a resource to support and compare data collected during focus groups and personal interviews. Copyright © Margaret Ann Stickney 2010 41 . and family benefits of the therapeutic riding program for clients with ASD. including the method of recruitment and the demographics of the subjects.

and social health of this population. physical. The sections on cognitive. The qualitative design provided the researcher with a greater understanding of the particular experiences of the intervention that could potentially help maximize the physical. social. class volunteers and staff members of the therapeutic riding program at Central Kentucky Riding for Hope (CKRH). social. and psychological benefits are each preceded by a discussion of normative childhood development for that specific area versus the classic limitations of autism spectrum disorders. and psychological benefits of a therapeutic riding program intervention for children with autism spectrum disorders (ASD). Kentucky. located at the Kentucky Horse Park in Lexington. which developed as an emergent theme during data collection. followed by the results of the study including the addition of perceived family benefits. based on the researcher’s assumption that appropriate interventions for individuals affected by ASD should work toward achievement of similar objectives in growth and maturation in the quest for optimal function and wellness. This discussion of developmental constructs also provided a framework for organization of the relevant themes presented by the data.Chapter Four Results The purpose of this study was to examine the perceived cognitive. physical. rather than what could be captured with standardized instruments. Participants Three focus groups and two personal interviews were conducted for riding instructors. emotional. Five riding instructors (one male and four females) took part in the 42 . This chapter first presents a brief description of the participant demographics.

The two female and 13 male children enrolled in the therapeutic riding program ranged in age from four to 23 years. reasoning. with a median age of nine years. and imagining. and one male and one female took part in the third focus group. and appropriate use of language (Edelman & Mandle. and instructor lesson plans and evaluations provided information for participant profiles. initial client evaluation forms. and data analysis. 2009). Results Cognitive benefits. Semi-structured interviews were held with the female Executive Director (45 minutes) and the female Program Director of CKRH (60 minutes). Records such as client registration forms containing medical information. 2002). degree of maturation.” Cognitive abilities include comprehending and retaining information. decision making and problem solving. judging. including native intelligence. adequate nutrition.first focus group. motor stimulation. One male and two female volunteers participated in the second focus group. which includes perceiving. The American Heritage Stedman’s Medical Dictionary (2002) defines cognition as “the mental process of knowing. Personal interviews were also conducted until saturation was reached with 22 parents or related caregivers (16 female and six male) of 15 children diagnosed with autism spectrum disorders who were enrolled in classes at Central Kentucky Riding for Hope in the 8-week fall session of 2008. recognizing. These interviews were held during the children’s lessons at CKRH and varied in length from 30-60 minutes. and sensory 43 . demographics. Optimum cognitive development is dependent on several factors (Murray et al. conceiving. following directions. All three focus group discussions lasted between 60-90 minutes.

hands. By the formal operational stage (11 years and over). perceive and deal effectively with the challenges of life (Murray et al. The beginning of a child’s symbolic thinking is expressed through language development and make-believe play during the preoperational stage (2-7 years). 2002. 2004. During the sensorimotor stage (birth to 2 years) the child explores the world through his eyes. then to a greater degree with mental processing. Piaget’s theory stresses contact with age and stage-appropriate environments that will encourage active learning through the discovery process. while logical reasoning and organizational abilities emerge throughout the concrete operational stage (7-11 years). 2009). Murray et al. The level of independent function attainable for any individual is greatly dependent on his or her capacity to think. and neuromuscular activities coupled with a child’s active interaction and experimentation with various stimuli in his environment. One of the most well known theorists of cognitive development. ears. physical. 2009). solving basic problems first with physical trial and error experimentation. through which he learns to readjust his thinking and solve problems (Berk. the child is capable of abstract thinking and consideration of many possible outcomes to problems rather than only the most obvious choices. and mouth.stimulation through social interaction and other activities. Edelman & Mandle. which can eventually include behavior and lifestyle choices that affect long term health. but consider experimental learning to be a more continuous process that is present to a greater or lesser degree throughout childhood and 44 . described four main stages of predictable levels of thought processing that evolve as a consequence of natural maturation of sensory. Later proponents of the information processing theory of cognitive development concur with Piaget’s basic assumptions. Jean Piaget.

2009). 2003). Both theories. or musical ability (Sadock & Sadock. and swinging. the condition is more typically marked by deficits in intellectual functioning and uneven development of cognitive skills. Difficulty with language processing and usage is a principal criterion for diagnosis of autism spectrum disorders (Sadock & Sadock.not rigidly relegated to specific age ranges. however. 2003). 2003). 2000). Sadock & Sadock. spinning. and typically display a short attention span and poor ability to focus on a task (Sadock & Sadock. In general. rote memory. One third to one half of this segment will be categorized in the mild to moderate level. Approximately 75% may be categorized as mentally retarded (American Psychiatric Association. 2000). 2004). Many seem to enjoy or require vestibular stimulation such as bouncing movements. The amount of sensory stimulation provided as well as the individual’s perceptual capability will greatly affect the functional cognitive level each child can achieve. emphasize discovery learning through direct contact with the environment (Berk. 2003). Although some children with autism spectrum disorders (ASD) may possess exceptional cognitive skills in one or more rather narrow areas of functioning such as mathematical calculation. Both language delay 45 . although children diagnosed with Asperger’s syndrome do not typically experience delays in cognitive or language development (American Psychiatric Association. 2000. children require individual attention and encouragement to participate in a variety of tasks and activities that can provide opportunities to learn more about people and the world around them (Murray et al. with the balance in the severe to profound range (American Psychiatric Association. Individuals may alternately exhibit either hyper or hyposensitivity to sensory stimuli.

and it is common for individuals to experience more difficulty in receptive than expressive language (Sadock & Sadock. Individuals who are verbal commonly exhibit abnormal patterns of speech. 2003. Much emphasis is placed on therapies designed to augment language abilities for children with ASD. as well as those for general cognitive development. Some children demonstrate unusually high levels of reading skill. Parents of 14 of the 15 children noted opportunities for improvement in one or more areas of their children’s overall cognitive function. it may be hard for him to create meaningful sentence structure and difficult to understand questions. Increased processing opportunities. 2000). as both intellectual level and proficiency in communication skills are critical factors for long term prognosis (American Psychiatric Association. These recommendations. including stereotypical. or hyperlexia. Children with ASD may initially demonstrate some normal language development but regress later on (American Psychiatric Association. American Psychiatric Association. and intonation. at an early age but have little comprehension of the material. thus dramatically limiting his communication capabilities. Even if an individual possesses a relatively large vocabulary. repetitive or nonsensical vocabulary and unusual pitch. Since CKRH client applications require input from both the child’s physician and parents or legal guardians. 2000). lesson plans can be designed to provide activities that will complement the unique needs and concurrent therapies of enrolled individuals. directions. 2000). lend support to any type of intervention that provides appropriate sensory stimulation and opportunities to actively explore and interact in a supportive environment. Dave’s mother reported “…that’s always good for 46 . rhythm.and language deviance may be exhibited. or context in the speech of others.

Shirley bears witness to the cognitive challenges each rider is required to undertake: 47 . riders are also asked to perform a variety of other tasks while mounted. “You gotta keep your heels down.anybody to have to think about what to do.” Doug’s mother values the parallels between therapeutic riding exercises and her son’s other interventions: …the instructors come up with particular activities that also work on…cognitive skills and language skills. and you’re having direction come at you. and hold your reins. so I think that’s good for him to have to process…what he needs to do to control the horse. Like I remember when my mom took lessons. then you have to pick up the ring and ride to the next barrel and put the ring on the cone and then pick up your reins and…you’ve got all this stuff coming in at once… And it’s a lot of stuff. “Yeah!” From her perspective as a volunteer in one of Deb’s classes. you are doing like 10 things at once. and do all this stuff at once?” and I’m like. so not only are they sitting up. and she couldn’t believe it – she’s like. And provides that sensory input… Many activities planned by the instructors during therapeutic riding classes are designed to provide opportunities for increased cognitive processing. as described by Deb during the instructor focus group: …when you ride. so this program is so terrific because it gives him an opportunity to try to apply some things that he’s working on very specifically in speech and in OT and in PT and it just kind of pulls that all together. holding reins. While learning to balance and control the horse is considered an important goal.

as she discusses during the first volunteer focus group: I think the repetition is good for a lot of the students because…like taking the rings down to put in the cones. And I think that—it would be something that should carry through… Instructors and class volunteers often readily note improvement over time in each rider’s ability to complete similar activities which are typically repeated in subsequent lessons.. Deb reports on the progress of one student in the study during the instructor focus group: And…once we do like an obstacle – let’s say we’re taking a beanbag from the bucket and putting it in the mailbox – he knows that once we stop and put it in the mailbox. today you have to look where you’re going…if you’re going to go to that end of the ring. it’s reaching over and doing this and it’s a color match and it’s like a lot of things going on.K. because it’s a memory kind of thing—a retention…and it’s also physical.’” He knows that that’s the next step in the course.…what Deb’s really…been working on. you have to look…” and so she’s done a lot of little things like that that the goal…was to ride with reins in one hand and open the mailbox…to make them try to figure out how to do something like that. Volunteer Sherry can also appreciate the combination of physical and mental processing required to complete class activities. and he doesn’t need us to say. “O.. “O. but I think the knowing what you’re expected to do…to hold that in your mind and be able to do it. it’s been really good for some of the guys I work with. now you say ‘Walk on. he knows to say “Walk on!” That’s the next step.K. 48 .

Proper maturation of the nervous and endocrine systems allows the acquisition of physical skills (Murray et al. 2009). the ability to learn is greatly affected by sensory function and the stimulation of the visual. In preschool age children. realizing that reading is one of his strong points. Sensory input. Bob’s mother notes that instructors. including Gary’s mother. aural. “…he still requires a lot of sensory input and that’s why this program is so good for him… It is definitely helping him and…giving him some wonderful sensory input which you just can’t duplicate in any other form. Nine caregivers reported a desire for improvement in this area. maybe some different sights and sounds and smells and things that he wasn’t used to. often ask her son to read successive clues on cards previously hidden around the riding ring in order to complete a treasure hunt activity on horseback.” 49 . For example. Cognitive development theorists observe that normal cognitive processing in the growing child is dependent upon the development of motor activity. The therapeutic riding program is often chosen by parents because it provides an environment with a variety of sensory opportunities that may prove useful for clients with ASD with reported sensory issues.Instructors can utilize a child’s known strengths to elicit performance in activities that target weaker areas. which involves the cognitive ability to consistently focus while completing a series of instructions. “…I just…expected him to be able to experience a new environment. To get used to being around some new people and some different sensations…” Doug’s mother reports. which then leads to social interaction capabilities. and tactile and kinesthetic sensations through various activities.

any type of animal. He needed preparation. while others may exhibit abnormally high pain thresholds that can put them at risk for injury. And that was apparent that he was not prepared for that. the whinnying and…the activity of the barn.” The range of individual sensitivity to sensory stimuli can vary widely among individuals with ASD. describes the early reactions of her client: When she started. The sounds. which often leads to behavioral meltdowns. Program Director Denise had a similar experience with John during his initial intake evaluation and assessment. the environment. both from the pressure of bouncing on that horse to just the different textures of the horse. Strategies for introducing sensory stimuli to clients are. The whole nine yards. of necessity designed to meet their individual needs. 50 . and start with assessing him at a mounted activity. planning and introduction to be able to accept this environment for all of the sensory [stimuli]…so we brought in a mini [miniature horse].Bob’s mother agrees. and therefore adjusted her approach accordingly: …he came in on his first days with a high level of fear…really…over sensitized by the smells. It is common for many of these individuals to easily become over stimulated. she wanted no part of that. the touch…really over stimulated…and we had to work through some of those [issues]…we began first trying to introduce him to…an average size horse. Jan’s instructor. that just overloaded her…so we started very slowly. the animal itself. Mary. she could not come in the end of the barn…she was terrified of animals. “I think it’s the sensory…input he gets. therefore.

as volunteer Shirley describes. and I sent two helmets home with her and said. so then she got to carrying it. as illustrated by Program Director Denise: …a helmet is a difficult thing. [you have to learn] how to hold them.Physical contact with the children themselves can present difficulties for instructors and class volunteers who often find. “some of them don’t like to be just barely touched…if you’re going to have contact. not that it’s over their ears but it can affect [them]…it’s definitely a tactile touch thing.” The riding helmets that are required at all times while clients work around the CKRH horses provide some of the biggest sensory challenges to staff and volunteers working with participants with ASD. “Here you go. it’s all so many. That was another thing…that pressure on her head.” Wear it…try and see if she’ll even carry it. tons of things. Practice – wear it when you’re watching TV. so she shows up for the next lesson and she already has it on! Gets out of the car and she already has it on. I mean it’s a balance [thing]. That’s…addressing a lot of sensory issues. “Now she wears the helmet every time she walks in the barn. Instructor Mary recounts Jan’s initial struggles with the helmet requirement: …she wouldn’t even put a helmet on her head. as Jan’s father asserts. Wear it when you’re riding in the car. It can affect the hearing.” John’s aunt’s fears that 51 . Helmet compliance is readily recognized by parents as a benchmark sensory accomplishment in their child’s therapeutic riding experience. It’s a space thing…my body awareness is a lot different with a helmet on than off.

And so two or three years ago. and various props used during the riding lesson activities.his early refusal to wear the helmet would preclude his participation were eventually assuaged: …they said that he could not ride without the helmet and he has a sensory issue. He’ll watch her and he’ll…like…watching her mouth…and…he won’t touch her face or anything…but he will touch her neck…I think eventually he will. And a dog could walk right by him. As Deb describes during the instructor focus group. “has really helped. And then when we did put it on. before we started. He would rather look at a tree 52 . And he would not even let us put the helmet on his head. he wouldn’t pay any attention. he would kind of cry…and fight us a little bit. “I mean it depends on the student.” Sherry notes in the first volunteer focus group that having some of the clients groom their own horses.” The gradual introduction provided by the staff and volunteers to the tactile challenges of the barn and riding ring are generally rewarded with client compliance and an acquired desensitization that can be applied to other aspects of their lives. But now he’s got to the point where he just holds so still and lets me put it on and…he’s great with that. And…they started out by letting him kind of touch her tail…Just…touch…And then he moved up to the mane…you know he loves to play with hair so that was a positive thing…there. it was not pleasant. Other tactile challenges include the different textures presented by the horses. the grooming equipment. he wouldn’t touch any animal. the tack. I see some of them that are initially…that the feel of the brush is very foreign. as related by John’s aunt: Yeah…he loves to watch Socie now. but a lot of times with…children with autism…they have problems with different textures.

Four parents reported increased skills in this area. She can get it off the shelf. I mean when I see that I know it’s from Socie. She will come and get her grooming box. Staff. in order. two years. “Turn left Rick. she knows what color it is. including Rick’s father: …especially within the last year and a half. he even ran over and touched the tail of a cat.” or…“Turn right. It’s from his involvement with an animal. the order we do ‘em in. so…that’s just a continuation of it so it’s great.than an animal. and most kids want to look at the animal. instructors. motor planning issues [have improved]. Mary described Jan’s improvements in cognitive processing as related to successful motor operations during preparation for class: And…now we do our sequence of events. she carries it back.” It’s…“Go to the mailbox. Robin’s mother reports similar observations: 53 . The…steering. Understanding that. and now they’re even moving beyond that to more generalize instead of going. right. she picks out her grooming tool…she grooms her mini…then she leads her. During the instructor focus group. Motor planning. And so now when he looks at that cat or dog and he even laughs at them sometimes. actually learning to control the horse. doing the whoas [stops]. and volunteers noted improvements in motor planning skills of clients as reflected in both non-mounted and mounted exercises. So [increased] confidence level from that…he understands left. left and right. and she knows this.” so it’s moved from a very definitive to a more abstract.

…And even going around corners and curves. I’m going to control where this horse moves. So he realized. as Executive Director Pat explains: That spatial awareness…comes into play with that too.” So I thought. that was enhancing his motor planning. “Oh my gosh. So…and then we started noticing that he was anticipating changes in speed and direction. Or even my posture will affect how the horse moves. I mean. look what’s happening here. you get too close to a horse and in somebody’s space you might get your foot stepped on or your might get…knocked by the head or something. Again. 54 . So I think people learn a lot about spatial awareness and what’s appropriate. “Gosh. coming close to you. his eye-hand coordination is probably really improving out there. his motor planning is probably improving with all this” because he had very poor motor planning. Awareness of one’s body in space is crucial for the balance and coordination required to perform motor activities. Proprioception. oh my gosh. “If I control my hands.And then…we started seeing that…he was doing these activities like the ring toss and bean bag toss and I thought. “How am I going to do this? How am I going to get this horse to turn to the left when I want him to turn left and to slow down so I don’t fall off?” So that. as well as to prevent injury when working with large animals.” And…then we started noticing that he was learning how his movements and his posture was affecting the horse and the horse’s movement and posture. And then he was learning how to control them both. and he was really having to anticipate….

“…so as we’re working on heels down in the saddle… proper positioning.…equitation …it’s part of that motor planning. as described by Jim’s mother: Part of that has to do. listening. or focus. He used to just…run into things all the time.” Three parents referred to challenges in this area. Definitely his physical and his body. It’s a part of identifying…where our body is. of course. “…he’s doing so much better with…listening to directions is another big thing because he always has had a really hard time with that. of course this works on all of that. family members of seven of the children considered increased concentration an important benefit developed on horseback.Program Director Denise describes the interaction of proprioception and motor planning during a riding lesson. Wayne’s mother reports. And…then he…would run into someone and look at them like…. Like where his body is in space. with dealing with the physical aspects of his disability.” Both of Gary’s 55 . Kerry’s mother sees improvement in her 6 year-old’s proprioceptive deficits: … riding has just really made him maybe become a little bit more aware of those things. Focus. the vestibular stuff and not being sure where his body is in space and all of that. Whether described as attention span. “Why did you run into me?” Older clients also profit from the challenges provided by horseback riding. Our body awareness and those type things. And not having to concentrate on keeping his body upright and wondering where it…where things are coming at him from. So to see him listening to directions on a consistent basis is really nice.

Increased attention span and focus helps the riders understand and complete tasks required of them during their riding lessons.” His grandfather remarks. “I think he’s absorbed by it. I don’t know. from what I was told.grandparents and his mother considered this to be one of the most important effects of the program and mentioned it multiple times. “…I think. ‘I’ve had enough’…he goes right down to the wire. He never…asks to get off. Gary’s grandmother says. or else maturation. he would focus the whole time that he was on the horse. till they finish with him. Family members such as Gary’s mother 56 . but I have to think that that helped because then he was concentrating and gradually got better. yes. Caregivers of six of the children reported improvements in following directions.” The following description by Gary’s grandmother illustrates the classic difficulty of interacting with children with ASD and summarizes the observed positive effect of therapeutic riding for children who exhibit this symptom: So…a lot of times when you talked to him it’s like it didn’t register…like…it didn’t reach him. as deficits in receptive language skills can cause difficulty in interpreting verbal instructions. when he was on the horse. Following multi-step directions is a commonly-stated lesson goal for clients with ASD. He never says. Following directions. So once he started with the hippotherapy. So I think it carried over. He’s either far off or it just didn’t make sense to him. for whatever reason when he’s on the horse he concentrates better…the thing to me that’s…the most beneficial is that it causes him to focus…to train his mind to focus because that was a big problem. where most of the time he’ll hear you.

he’ll lift his arm. It seems like it’s getting better than it ever used to be because he used to have to have each direction…single directions before he could do it.” Jerry’s mother has seen a change over time in her son’s performance. “Well…generally when he’s on the horse. as described by volunteer Alex.frequently report a greater willingness to do so while mounted on a horse. who attends most of his lessons. We’d say it to him and he wouldn’t repeat—so that’s where you don’t know if he’s getting it or not. notes the observed progress with that client. sometimes he doesn’t. this is what you have to do. He may be more likely to pay attention better.. adds.” Shirley. and then usually he repeats it back. …He does very well and…a lot of times they’ll do…like a little game where they have to…take an item and move it to another place and…they give them the directions and say.” And sometimes he has to be prompted again. “O. if they say lift your arm. “I know…with Dave I just kind of keep the instruction shorter. To focus his attention better…follow what people are telling him or asking him.” 57 . what you tell them. and now you can give him a few directions and most of the time he’ll be able to do it… Instructors and volunteers are cautioned to keep instructions to riders as clear and brief as possible. “…he wouldn’t do that when he first started riding.K. “I think…he learns to follow directions a little better when he’s on the horse. he seems to do.” Gary’s grandmother. without a lot of unnecessary verbiage. “…well I’d say that he definitely follows more direction now. Whatever they tell him when he’s on the horse.” Wayne’s mother observes: …just learning to follow directions was a big thing…because he…just didn’t have that skill. who volunteers in the same class as Alex.

as Wayne’s mother explains.Mounted games and exercises that the riders typically enjoy are regularly included in lesson plans designed to give as much repetition as possible to following directions. gradually increasing the number of steps involved per verbal instruction. But it seems that because she’s so interested and she’s so on task. resulted in Jerry appearing to overcome some of his negative behaviors while rising to the greater challenges of that environment: …the first year I was here the parents wanted him to be in Alan’s class… So. so that when those directions are given to her.I came to Alan and said. “…and that’s what they basically play is Red Light Green Light.. which is also an issue… It’s difficult [for Meghan] to follow directions.. And he just loves that. “They’re just insistent they’re going to quit riding if I do 58 . especially following her initial reluctance to comply with his parents’ desire to move their son to Alan’s class. it seems that she is more able to process that. Problem solving. A higher level of cognitive development includes the ability to solve problems.” Meghan’s mother also connects the riding lesson experience to this area of cognitive processing: …and Marsha has been very good with helping her to follow directions. And it’s neat because then he has to watch and pay attention and follow the directions. Eventually allowing him to participate in the class. however. Instructor Denise was pleasantly surprised to see the progress made by Jerry in this regard. Denise didn’t feel Jerry was capable of handling the increased demands in a class where the clients ride more independently with fewer volunteers to assist them. and she’s on the horse and she’s got the whole nervous system involved.

All of those I think are decreased over the past three years…but what Alan has been able to bring out in his class. but ‘Go with it!’” And…what the parents saw that I actually did not see was a lot of abilities and a lot of independent thinking that was behind some inappropriate…. While discussing improved communication abilities. One child put their first sentence together and…strung words together for the first time instead of just repeating a word. Language development. They actually strung a sentence and the sentence was “I love you Annie. inappropriate chatter. That happened here this year. Meghan’s mother feels the riding program has served as a catalyst in encouraging language development for her daughter: 59 . is an ability that this child did have to…control his horse and to think and to problem solve. I think that’s what I was not seeing. I’m not really sure that this child is ready for this class.social behaviors that are still there – loud voice. I didn’t see him problem-solving.not sign him up in your class this session. Restricted language and communication skills are hallmark symptoms of ASD. inappropriate talk. First word ever from a nine or a ten year-old. Executive Director Pat depicts two separate incidents: A lot of times it’s the speech…you say your first word. I think.” which was the horse. was the horse’s name…And then…in the fall…the same horse. some inappropriate body movements in terms of gross motor skills. and it is common to hear reports of increased client verbalization from those associated with the CKRH program.

“Ready. three. this is a K.Meghan has severe deceptive expressive language disorder. as further described by John’s aunt: And they had these big letters out there now [on the fence surrounding the ring].” and he’ll say. “Go. “K. like A through K and I don’t know how far it goes up…they have a little one that matches each letter. They’ve got him doing that. And they get them to say… “Look John. Two closely related sensory concepts related to the riding program are repeatedly credited by interviewees with creating positive effects across all perceived health benefit areas are the deep pressure stimulation provided to the rider while mounted on a horse and the motion of the horse itself. sharing information.” And they stop Socie while they do that and then after he says it and he throws the letter down.” Or.” and he’ll say.K.. then they go. and they do counting also…they’ll say. one.”…and he’ll go up to 10. Such impressions were first mentioned during the 60 . “1. 2. 3. John’s aunt lists this as one of the two most important benefits her nephew has received from the program. “O.” Effect of horse’s movement and deep pressure. And they’ll say. which is something that’s very difficult for her to do. “Go. If she talks about the horse. …And so they’re working on that.” and he’ll say “Two. “And…plus just…the increase in his vocabulary…that to me was a big plus because we thought he would never talk.” And then he’ll say. Say K. But I think that I feel that she has increased her ability to express herself. set.” Participants with ASD are routinely required to respond verbally in order to complete exercises and games in class. She was not verbal in terms of meaningful communication at all when she started on the horse.

especially at the faster paces. He remarked that Wayne just chills up on the horse. because he wants to feel…his sense of smell is strong and his touch is very strong. a pediatrician. his aunt immediately replies: …I feel that it is totally the motion of the horse…. When asked to what she would attribute John’s progress. but he does like the…horses that are going to move and bounce…because he likes that deep impact…I think it goes back to…his proprioceptive…needs…his sensory integration needs…because…to ride on the horse. 61 .The motion and the warmth of the horse’s body against his. I mean. plus the elliptical movement of the horse’s stride.instructor focus group and proved to be a recurring theme. he likes swimming because that’s a fully body…you’re completely surrounded by…pressure. and also enjoys bouncing at the trot. He feels this may have a neurologic effect that can transfer to behavior change. you’re going up and down and you’re bounding and you’re getting deep pressure all up and down through the trunk. And he loves to just kind of massage Socie’s neck. his father describes a positive effect of deep pressure provided by horseback riding on his son’s sensory integration: All he wants to do is ride. even after having the worst day. Although Rick initially had problems with deep pressure sensitivity. liquid. Wayne’s father. was the first parent to describe the overall benefits of deep pressure and the large base of support the horse provides. So he likes deep pressure to this day. as…the gravity’s hitting so…from sensory integration…that’s great. And he doesn’t care.

” In describing Robin. as Deb remarks. Meghan’s mother expresses her belief in this concept: How that’s supposed to…increase learning and awareness. as described by Meghan’s grandmother. John’s aunt feels the motion and pressure are responsible for nephew’s improvement in language deficits: …the jogging like they did just now…he loves that. So I think it does increase her…ability to understand and listen and… process that information. And that’s why I say that I think this is what’s helped him and his in home speech therapist…told me one day that he felt that his progress thus far has been because of the horse therapy…So it’s not only me…it’s from other therapists… Instructors also feel strongly about the crucial link of equine movement to student progress. and helps keep them involved. …and …that makes me believe that the motion of the horse is what’s giving him the stimulation that he needs. “…when we’re talking about students with sensory integration problems.Children with ASD often display stereotyped movements and behaviors that may fulfill a need for sensory stimulation. Denise remarks. and then we went to the mounted activities and started 62 . But this way she’s getting her whole body into it…She’s even pulled all her eyelashes out at times…. And I think a lot of that is going on when she’s on the horse…just naturally. “…she needed that stimulation and…there’s times when she rubs her eyelashes and it gives her a sensation. “He developed trust for the animal. the motion of the horse is so huge…to this…and that’s what really helps them focus.” Many interview subjects observed that the pressure and movement provided by the horse may fulfill this innate sensory need and thus allow more normal cognitive processing. because of the movement.

they’re relaxed. then you start branching into the touch of different objects. Physical benefits.. Motor development. and you’re getting the benefits of the movement and so then they’re calmed. a dynamic relationship exists between normal cognitive and physical development in preschool-age children. As the toddler’s center of gravity moves toward the center of the body during head-to-toe growth. all of which are required for acquisition of motor skills. in turn. stimulates maturation of cognitive skills (Berk. As mentioned earlier in the chapter.obtaining the benefits from the movement and things like that.. perception. the individual doesn’t have to touch. attention. So then you start branching into the touch of the horse.” Denise employs the motion of the horse as a foundation for tactile exploration exercises for students who are hypersensitive to touch: …and I think also the tactile – the touch…we improve individuals’ acceptance of a variety of touches and a variety of feels. 2004).So in terms of the movement and going back to the tactile and the touch. So you start addressing the touch but it’s after the movement has occurred. And then you get on. They do not have to accept the feel of the horse itself. The horse hair is something very different from even a dog or a cat…and so when you have that movement of the horse. Brain development allows for improvements in coordination. they’re more organized and they’re more accepting of the touch. and memory. improved balance and strength 63 . the individual with the diagnosis of autism doesn’t have to touch the horse first…oftentimes I’ve covered the pad [that the rider sits on] with something that’s familiar with them.

or steering a bike. many do exhibit problems with coordination. Opportunities for physical activity encourage normal physical development in children. start. catching. all of which involve coordinated efforts of the limbs and large muscle groups. coordination. the rider may also be asked to perform stretching exercises. and maintain balance over his or her mount while maneuvering the horse around the riding ring using hand and leg aids to make the animal turn. At least six of the children in this study have received or still participate in occupational and/or physical therapy. and strength that can restrict normal development of both gross and motor skills. Therapeutic riding encourages improvements in muscle and core strength. dismount. walking. stop. yet the 64 . Aided by the horse’s leader and the sidewalkers. and jumping. Greater proficiency in both upper and lower body gross motor skills supports the development of the smaller muscle groups that perform fine motor skills such as grasping an object between the thumb and forefinger. and change speeds. change positions in the seat. ride with eyes closed to concentrate on balance. Horseback riding is a sporting activity that requires physical exertion and proper conditioning to perform safely and effectively. flexibility and proprioception as the rider is required to mount.lead to gains in gross motor skills such as sitting. running. Although physical deficits are not classic symptoms for children with ASD. balance. who typically acquire these necessary building-block skills through the activities of play. As the child becomes more proficient in gross motor activity. balance. the torso is then freed to permit actions such as throwing. or throw and catch objects at a variety of angles. A causative factor for such limitations may be the typical social withdrawal feature of ASD that results in a lack of interest in interactive play with other children and reluctance to participate in physical activity or sports as the child grows older.

…and she’s been at this five years…now she gets out in the yard and runs and plays a little bit when they’re 65 . this is really good exercise! Everything gets worked.therapeutic riding program is routinely credited with greater enhancement in physical development. “Yeah. To see her doing something physical is always good. with agreement from the group as to the exercise potential of this activity: Well. or softball…They don’t swim. In speaking to her daughter’s lack of regular exercise. they’re never gonna exercise.” Jan’s step-mother remarks: Well I would say that…not only is it…a good activity outside of school. but I’m guessing most of these participants don’t play soccer. but it is good for her physically…she has to use her muscles…this is so unique…I mean she uses her arms to pull the horse… Jan’s grandmother elaborates on other factors restricting children with ASD from team sports: This is her thing…I can’t think of any sport she could really participate in…for one thing she wouldn’t understand a lot of theory. And as we all know. and they don’t do all these other things that other students do. I mean. I don’t know for a fact. Meghan’s mother says. Opportunity for physical activity. Barb described the lack of physical activity options for clients with ASD during the instructor focus group. so they don’t get a lot of exercise. so… I think it’s good physically… Seven caregivers identified the opportunity for physical activity as a benefit for their children.

and climbing.trying to play ball and stuff. and proprioception are all necessary for proper development of gross motor skills such as walking. 66 . Opportunities for physical activity through team sports may grow dimmer as a child with ASD reaches adolescence and restricted social skills exert a stronger influence that can preclude the child’s participation.. and coordination.. Well. So this has seemed to be a sport or an activity that he could participate in. balance. Gross motor function. right…that’s the best I can do in one word. he’s our only child too. but not good enough to play regular ball because you know that gets pretty competitive. Because he has a tendency to be kind of focused. as Dave’s mother describes in discussing her expectations for this program: . And…she’s not going to be picked for a team or anything… When asked to sum up the therapeutic riding benefits in one word. So he kind of has a tendency to…play with his own things…play on his computer…he’s not really had the social skill. And she knows that she’s doing something new and different and challenging… And I see so many good things…but…just the participation…for her to be learning this skill…and to be participating.I think just an activity that he could…participate in. It seemed like team type sports…he did the challenger t-ball but he was kind of better than that. …And it gives him activity. Jan’s father echoes the same sentiment: She has been so sheltered and unable to do so many things that it’s like…her chance at soccer or her chance at…some kind of sport. That’s hard to do. Strength. running.

they’ve put rings on stuff. just where they are in space. Volunteer Perry notes. Denise describes the value of balance and strength development for clients with ASD as well as for those with disabilities presenting with more physical limitations: We don’t necessarily think of…individuals with autism.. “…they do lots of balance things…. has observed changes in the riders’ physical ability and eagerness to mount their horse independently following eight weeks of lessons. Riding class activities are structured to include exercises which help the client to develop the basic physical skills needed for gross motor function that can be transferred to daily life skills. take stuff in and out of stuff. The necessity of mounting and dismounting from the horse at each lesson is perhaps the first action that provides a muscular challenge for the client. huge.” Another volunteer in the same class.During the instructor focus group discussion. Jo Ann. as well as everybody else. and how does that relate to day-to-day life?…walking up steps without holding a rail”. take rings off of stuff.we’re improving core muscle strength. …lots of those balance and mobility.they play basketball.and I think that’s a huge. “. If an individual is on a horse. I’ve seen a vast improvement in most of them in that area. Instructor Denise describes. “Well.. Barb adds. Where their bodies are is how movement affects – things that we don’t even think about.. “As far as the core…their abilities…as far as mounting and dismounting.. . Core muscle strength is something we automatically think of with individuals with CP…and some other things like that. “I’ve seen Alan do a lot of balance exercises. Core muscle strength affects everything.” Bob’s mother agrees.we do a lot of rings on cones and poles…and then they have 67 .” Mary describes the therapeutic goals of such exercises.

volunteers and parents alike. you know. as weeks go on. or hypotonia. but as time goes on. Sidewalkers often are required to utilize a thigh hold. now. in which the arm closer to the horse is placed across the rider’s thigh for stability. But…you can see that from the time that they first started doing that. to get back in the middle. Class volunteer Jo Ann describes improvements noted in muscle strength.K. you 68 .” Strength.’ and he’d be around. Like it was nothing. And then they have to right themselves. ‘O. that they’re very apprehensive and tentative. “He would spin around like it was his job. Class volunteers who work in direct proximity to the clients may be the first to appreciate changes in a client’s physical skills. if you are hanging on to them. methods or drills he has observed to be most beneficial for the clients he assists. Nine of the children’s assessment forms report evidence of low muscle tone. And enjoy doing it…like Wayne.to right themselves…A lot of eye-hand coordination. The positive results of such therapeutic riding exercises for clients are noted by instructors. they do it…rather quickly actually. pick up their reins…” When asked what procedures. “And you can feel it in their muscles. Volunteer Jo Ann agrees with the popularity of this drill for Wayne in particular. volunteer Perry replies: I think probably—and this is something I’ve never done on a horse—is ride backwards…to be able to maneuver around on the horse while it’s moving… requires a lot of coordination…that has to be developed over a period of time. He would hear the. and seven caregivers reported gains in core or general muscular strength.

their everyday life. even like the trunk strength. But I think this does help strengthen him… Core strength in particular is extremely beneficial for balance. but in the saddle it’s beautiful. And…of course we’ve been doing other things and…building. So we never had really any occupational therapy type needs. the core strength that some of them [have gained]…it’s like wow. posture.” Dave’s mother compares this activity to occupational therapy regarding improvements in muscle tone: I think the physical activity really helps him. When asked about the perceived physical benefits for her son. and movement. but you can tell…he sits really well in the saddle and he has a beautiful posture. So you know it’s helping all throughout their life. Had very little strength. I think balance. Kerry’s mother speaks to the noted improvement in the basic skills required for maintaining correct posture while riding: Physical strength wise…coordination. which he doesn’t always have the best posture anywhere else. not just while they’re here… 69 . Oh my gosh…you know he has tremendous lower body strength but he had very little trunk strength and especially when he first started. And to me this seems like this is kind of like occupational therapy because I think it does help build his muscle tone where he’s weak and…he’s always had the other skills…He’s been able to do…a lot of physical things like he’s always…been very good with his hands. Volunteer Sherry related the significance of the changes she has witnessed in the clients’ strength to functional life skills: Well.can feel it.

Sometimes we don’t think about that core muscle strength and how that core muscle strength affects our verbalization. but I think how it applies with individuals with autism. at home the same thing…he couldn’t sit for long periods of time. because of the poor muscle tone. you’re better able to do those kinds of tasks at school. I 70 .Jim’s mother additionally correlates adequate muscle tone in the trunk region with greater success in the classroom: Well…when he first came. Multiple factors of gross motor skills. which thus is affecting the communication…and what research has shown us is that when that core strengthens. don’t misunderstand me. he had really low muscle tone. He’d flop over and. and it increased his trunk strength. And if you’re not having to concentrate on keeping your body upright. then so does the ability to verbalize and so the speech increases. I mean. “…it improves their…ability to their flexibility. so—and he couldn’t sit up. You’re better able to hold a pencil. He’d be wanting to lay down or whatever. I mean he was always able to sit up and walk and everything. Instructor Denise addresses the interaction of the physical aspect of core strength with the cognitive development of language skills which are so often a limiting issue for children with ASD: …building core muscle strength is important no matter the diagnosis. their coordination…their…hand-eye coordination. but like in school. you can focus more on your learning. Perry speaks to improvements in multiple bases of motor function. he just couldn’t sit for long periods of time.

good for their—I don’t know. Meghan’s mother notes a regression in her physical skills during the off season from therapeutic riding sessions. Instructor Mary utilizes this measurement in her evaluation of student riding skills: 71 . Jo Ann explains: …mostly I think the reason that they’re on horses when they do hippotherapy and therapeutic riding is it helps them control their bodies.mean everything is improved…it gives them strength…” Speaking to the value of the horse as treatment tool for both physical and spiritual gains. So we thought. So I knew when he could turn four. So it was all kind of PT goals that I thought…this will be great for it. in between the riding sessions. was just hypotonia.” Adequate balance.. So I think it’s good for their posture. and core strength are required to develop a good seat while remaining centered atop a moving animal. gosh. that we would get him in Riding for Hope because I knew with this low tone that it would be great to get up on the horse because I thought…this is going to improve his range of motion and his…posture and his balance and…his endurance and strength.so as soon as we got on the horse. it’s good for their soul. Because you have to be able to control your muscles. proprioception. his posture got really really nice. or you will fall off. this is amazing. in order to stay on a horse. Robin’s mother initially chose therapeutic riding as an intervention for her son’s hypotonia. but has a keen appreciation for the multiple benefits for gross motor skills: …as I was pointing out to you out there when he got up on the horse. we noticed his posture improved. “…it did seem that she would take a few steps backwards with regard to her balance and coordination…things like that. or at least try to. …He…has low tone and that was his original diagnosis..

So I thought gosh. very weak. They can balance themselves enough. And then… we started seeing that…he was doing these activities like the ring toss and bean bag toss and I thought. as she describes: And then we started noticing that…he was having to grasp the reins. And…so I started noticing that his hands are getting stronger…So I thought…eventually this is going to—this is going to promote his handwriting. or thrown. and keep that going. Robin’s mother was one of five caregivers who observed gains in fine motor skills. gosh his eye-hand coordination is probably really improving out there. which can improve fine motor function. “Oop.” and if they can make that adjustment–if they can put their hands down and if they can take up rein while they’re moving. Once a child masters the basic skills of motor function. greater control of the muscles of his extremities allows the development of fine motor skills such as grasping objects and handwriting. and still manage to take up their rein. And his hands are very. this is great. when my students… can self-adjust while they’re moving…if I can say. 72 . you’re a little to the left…. He’s still—he can just barely do a tripod grasp. tossed. I think that that’s a huge milestone for them…. And he still has a very immature hand grasp. or concentrate on getting their heels down … Fine motor skills.Instead of having to come in the middle and stop. In addition to class activities involving the handling of objects which may be carried.I always think that’s a huge milestone. therapeutic riding also requires the rider to hold the bridle reins and learn how to guide and stop the horse.

The fine motor skills directly correspond to…the putting on his shoes and some other things. Development of endurance to maintain physical activity at the same level and to resist fatigue is another aspect of physical fitness that may be lacking in children with autism who experience limited physical activity. we’d never get that far. because before. but riding time can typically be increased as physical ability and attention span improve. very tired. Instructor Denise describes how this particular skill acquisition can readily be applied to daily functions of life: When you think about living skills. That directly relates to the buckle on his belt. Instructor Deb recollects Rick’s progress in his capability to hold the tools in his hands properly and to perform the necessary movements to correctly groom his horse: …when he gets down he can now lead his horse – help the leader to the back of the barn. 73 . …he’s always had very low endurance.Activities performed while assisting with horses in the barn following the riding lesson can also provide aid in fine motor skill development. when you think about individuals dressing themselves independently…he can now unbuckle the buckles on the saddle. He helps untack the horse – take off the saddle – and then he brushes the horse five times on each side. Therapeutic riding instructors carefully monitor clients for signs of fatigue during lessons. And it’s…just very exciting. Endurance. as Robin’s mother attests: He was doing the ring toss and—which were all good because he needed to be up on the horse balancing and practicing his posture and…just having the endurance because he used to get very.

including Bob’s mother: …Bob is not potty trained. ‘I need to go potty. do you know what I mean? Your legs would be aching and everything if you weren’t used to doing that. It wasn’t a whole lot though.” And we did stop and he did go some. We leave [CKRH] and he will say.” “No. he’d make it out there maybe 20 minutes.but then in the first few classes. … but she’s come out here and—I guess the stimulation…of what was happening and it 74 . I mean you’d be kind of tired. but…Yeah. she’s five years old. Meghan’s grandmother also describes this desirable consequence derived from repeated riding lessons: So I think this has really helped her…can you imagine to ride that horse for an hour and get off of there. Three parents credited the riding experience with their children’s progress in this important area of independent functioning. She was still not potty trained. but…it was just kind of a correlation and the way it happened and all clicked and we’re like. And now he can go a full hour.’ Where did this come from? …who knows. I mean it’s happened a couple of times… Meghan’s grandmother proposes an explanation for this phenomenon: My daughter really feels that it was a big reason that she was able to be potty trained. “Well!”…we put him off because I was driving and I put him off…like “Let’s wait. …you know. Toilet training. So I think that has really helped her too. It is not uncommon for children with ASD to experience delays in toilet training. I need to go now.

…she didn’t potty train until she got on the horse…she was five. six. Kerry’s mother has often heard this sentiment expressed by parents of children with ASD. and I had taken her home. and having a lot of trouble potty training. And one day she came home from riding and she had just gotten off the horse. And she gets out of the car and…kind of grabbed herself. still wearing pull-ups to school. lending credibility to the cause and effect relationship of increased pressure and localized body awareness: …as far as the physical therapeutic part of it I can’t begin to describe the difference there. “Yes. and just very quickly after that that she would get off and you could see that she was uncomfortable and that’s how we started.” so I took her straight to the bathroom. actually. was going to school and was actually probably in the second grade. Well that happened again after a ride. and acknowledges the effect of increased muscle tone. localized pressure and improved proprioception: 75 . “Meghan. do you want to go to the bathroom?” And she said.uses all of her body and the motions and the stimulation…we were able to get her potty trained after that… Meghan’s mother utilized this rationale in designing another stimulus that encouraged her toileting at home. We live very close. couldn’t stay dry during the day. So it was potty training and I think it was just development of the awareness of the sensation…her pressure sitting on the seat is the only time that she was ever aware of any sensation. So at that point we brought a bicycle into the house and let her sit on the bicycle and…we would have her ride around…and then we’d get her off and take her to the bathroom. and I said.

he just holds it in and he doesn’t realize. “Wait a minute.. do I have to go. And I’ve had other parents tell me…one child…was five and she wasn’t even potty trained yet. as described by John’s aunt: 76 . “Oh I gotta go.…My son has the low tone in his body. But it’s kind of a little side thing that I think has helped. that was it. He has a hard time with using the bathroom.he got potty trained really easy.I mean he didn’t make any mistakes or anything. The apparent need of a child with ASD for higher levels of sensory stimulation is discussed in the cognitive benefits section of this chapter.. wait. but…I don’t think he knows when he has to go…and then when he does. Two parents and several staff members and instructors reported decreases in the classic repetitive.”…and maybe it’s just physically being on the horse…but it’s…like a weird thing because…most kids—I’ve talked to lots of parents and a lot of their children have issues using the bathroom. stimming [stimulating] behaviors during therapeutic riding sessions. “I want to go to the bathroom…I want to go to the bathroom.. And it just— maybe pressure? Or they’re like. “Oh. And she started horseback riding and she immediately started saying. because some of them are just so unaware. he’s like. And I can’t help to think that this doesn’t help because a lot of times…right after. or what is this?”…we’re working on that. I mean once he…decided he wanted to be potty trained. Like he’s just…unaware of his body space in space.” And she would never even do that before…I think it’s simple awareness.” And it makes them think about that area of their body because they don’t always… Decreased “stimming” behaviors..

too. And he stays with his arms down. so they don’t necessarily have to do all those habitual… Deb: Just like I was talking about the student that jumps up and down…that jumps up and down and flaps. for one thing. She started toe-walking and doing quite a bit of odd stomping and things like that. I never would have thought that was possible…He stands there now when they bring Socie [the horse] in. He gets real still and quiet. The instructors offer a theory that links the motion of the horse to a reduction of stereotypical movements in clients with ASD during the instructor focus group discussion: Barb: Well. like for example. Meghan’s mother notes an increase in inappropriate motor behaviors when her daughter is not regularly participating in therapeutic riding: I think when she goes for a period. that a lot of these…people need. Now I have picked up doing Cardinal Hill therapy more because it seemed that she wasn’t doing well between the sessions. that gives him that… 77 . And so I’m just so encouraged by that…I hope that continues. they’ll finish up about Halloween and they don’t get to start back until about April…how can I say it? I don’t want to say that she regresses. So when I ask him to tell his horse to walk fast.He’ll do a lot of this [demonstrates “arm flapping” movement]…He’ll slap his side or he’ll kind of bite his hand sometimes…But I’ve noticed a lot of that going away. Motor activities that she hadn’t done before. or seek. but in a certain sense. they get from the horse. she does. I know that they provide movement. She wasn’t getting enough activity in.

And she will.Margi: Its own repetitive movement. sensory input? Deb: Yes. they don’t have to move to get that sensory – what is that called… Denise: Input. “He tells Socie which direction to go and so I guess they’ve worked some on how to operate the reins and getting the horse to follow…so he can be in control.” Meghan’s grandmother also speaks to the basics of rider control. I guess. Very strong. I mean he must. But…I think he knows some of the procedure. Deb: Yes. the horse does it for them Riding skills. they don’t have to move. Barb: So it allows them to kind of be still.”…And she’s very strong. when they’re looking for that sensory input. 78 . she’ll just pull right back on him…” Gary’s grandfather appreciates that Gary is mastering the correct progression of steps involved in the process of mounting the horse: But I did notice this evening. Deb: Yeah. Normally we’re sitting back…10 or 20 yards and we were right up there. “…like they’ll say. Certainly. “Now Meghan. Now he couldn’t… swing the other leg over. And he puts his foot in the stirrup and he grabs the rein. you control that horse. and it’s the first time I’ve been right up there beside him when he gets on the horse. Bob’s mother observes the beginnings of the rider/horse relationship. in themselves. The acquisition of the physical skills needed to become a better rider can reap multiple rewards. Make him stop. as described by seven family members as well as two class volunteers and one instructor.

By the end he was doing like 2-point riding [standing up with only his two feet for support]. rather than just…before he was doing…mostly I think therapeutic skills. Because classes are held in outdoor rings. he’s obviously very confident now on the horse. But. you know.Independent riding is a goal to which many clients and their families aspire. and so they didn’t. as illustrated by Kerry’s mother: Yeah. of course…and I don’t know all the different things that they teach him. a lot of heat days. 79 . they’re teaching him more. which was kind of a bummer. Because…I noticed a huge significance from when he did the whole way through. Robin’s mother describes a transition from the original therapeutic goals to attainment of the required skills for this sporting activity: …they’re giving him more responsibilities. trotting. They didn’t do the summer this year because they said…there was a lot of rain days. and he’s learning more skills. So I think he’s actually going to become a rider now. they used to do the summer. the riding season and even individual class sessions are often interrupted by inclement weather. An irregular riding schedule can cause a regression in learned skills. Steve’s mother appreciates the opportunities provided from the move to a more advanced level class: Well…they’ve taught him…how to guide the horse. you know as far as standing up in the stirrups and riding and he gets to ride a lot more independently…in this class than what he did the other. cantering.

Development of motor skills is a crucial step toward the goal of independent functioning for children with ASD.” Responding to a question about overall perceived benefits. His well-being. They all adore it. in fact. as reported by Dave’s mother. I think it was—it does a lot for him. And they’re very good. just moved into the big ring. as far as like occupationally. Like we see them laying down and having to pull themselves up to get their stomach muscles. he is…[and] he’s a good rider. Jerry’s mother described: …physically…you know they do a lot of exercises. this sort of thing. One. And they ride sideways and they ride backwards and…physically. Shirley: He is. He’s doing a lot better…I’m thinking of…Jack…I love Jack. “…I think this helps develop just his physical being. Ten family members credited participation in the therapeutic riding program with improvement in their children’s overall physicality. They love it. “So…he’s working on some…fine 80 . Doug’s mother appreciates the positive effect the riding program has on both gross and fine motor function. And then they moved on gradually to riding. What a hoot. Sherry: Yeah.Jack’s class volunteers readily support his mother’s observations that her son has moved beyond basic therapeutic activities related to cognitive and social skills and is showing a real talent for maintaining good balance and control while riding his horse: Sherry: I’m thinking of some little guys that we just… started out with in here and helping them learn to focus a little bit more and…be aware of emotions and facial expressions. he’s a little Velcro bottom Overall physical well-being and transfer of skills gained to daily life.

and now all of a sudden this year.” Wayne’s mother describes challenges her son has encountered and improvements in which she feels therapeutic riding has played a role: It’s helped his…trunkal [sic] strength has really improved…we’ve noticed just— now I don’t know if it’s just because he’s getting older and stronger or if it’s actually from this. Proficiency gained in therapeutic riding may stimulate interest in participation in other physical activity.…but he does it really well now and he’ll run up and down and it’s like nothing ever was different. but like last year. he makes like maybe five trips around. So…[we’ve] seen a lot of improvements through a lot of the physical and like I said. yes. that’s good walking…And so we’ve seen that. but you can tell it was…something a little more difficult than it should have been for a 7 year-old. I’ve seen some…improvement in that area.motor…when he’s holding the reins…he’s working on…trying to strengthen fingers and…he’s working on gross motor just to be able to climb the steps and learn to swing his leg over on a horse. Jim’s mother credits improved physical conditioning to gains in social skills: 81 . as illustrated by John’s aunt: …physically I’ve seen him be a little more active…before he didn’t do a lot of running around…And here he actually. he couldn’t hardly get on the bus by himself and climb up the stairs. he can just about run up the stairs. you know I’m sure it’s had something to with it. You know that’s. …and…at home he will still…hold onto the railing and go up and…not struggle. I don’t know if it’s just this or. And I take him to a park in Berea and they have like a walking trail behind the school and he actually leads me now…And he used to—he wouldn’t even walk like from here to where they are… So.

82 . Meghan never falls because Meghan never moves in such a way to allow herself to fall…and she struggles. Although she acknowledges multiple positive outcomes from therapeutic riding. She’s very slow and deliberate…she just never falls because she’s very careful. like…the fear of being up off the ground and just not having the endurance to complete an activity like that. Both Meghan’s mother and grandmother frequently refer to Meghan’s difficulties and subsequent improvement in basic coordination. just even getting out of the car is a struggle. Although her mother does not regularly observe the riding lessons.And to be able to actually enjoy the people…yes it’s helped the socialization. But even just getting over some of the physical things that kind of kept us from doing some of these things initially. bless her little heart. The self care thing. that was huge for us. Robin’s mother believes success in this program has provided a basis for other functional skill acquisition: I don’t think I could choose one because. To see her doing something physical is always good. yeah…they’ve really made such a huge impact on his life that everything has just been—one thing can’t outweigh the other. Four other parents describe an innate fear of physical activity that had severely limited their child’s participation in physical functioning. she appreciates the opportunity provided: …and she’s very hesitant. But I think that’s partly just because he’s had the chance to socialize and partly because of the improvement in his physical condition…so that he’s able to more concentrate on those things.

Of course. Rick’s mother relates an example of transference of skills learned in therapeutic riding to her son’s previously-disappointing trips to a local fast food play land: 83 . she needs all that. those fears…he has a fear of heights and I think some of it’s the depth perception and things like that…it was that he could not walk up the steps and get on the horse that way.” Meghan’s grandmother echoes this theme: She’s very hesitant and cautious…physically it’s made a difference. apparently now he’s looked at steps and climbing up the horse that way.. Bob’s mother has witnessed her son’s progress in overcoming a fear of heights that she feels is directly related to the necessity of climbing the steps of the mounting block at the beginning of his riding lesson: …it does help with his balance. “…getting on and off. You know. Somebody had to lift him up. as he used to be.. because she was very awkward…clumsy…very cautious in her walking and everything. it was very frightening at first. But that movement from sitting there to the ground just was a big fright. He’ll climb things a little bit higher and I don’t know if that’s a good thing or a bad thing! Depends on what he’s climbing on. her mother continued. It does help with those coordinations. in the whole body. which…she needed that stimulation and that kind of—yeah. they say.and he’s a little more—he’s not as reluctant to be at those heights. she does this and I think that uses all the muscles. We see it just in the different stuff he’ll do at home.Asked if Meghan were initially fearful of riding. So it’s worked. well. Not while she’s on.

never been able to climb up in there.K. 84 . But before that. I mean. and…I think he was getting ready to start the second one…[We] all went to the Burger King…We walked into the gate. And…he had finished…his first full session…the six weeks or eight weeks…of horseback riding.K. And I am freaking out because it’s Richmond Road. “Is he alright?” They were like. so he didn’t want to get on swings. he’s alright. and that’s all he could do. “Yeah. O.… I turned around and I didn’t see Rick.When Rick was younger…up until he was. Rick could not go any further than the first step at McDonalds Play Land. I guess probably three and a half. Robin’s mother describes similar improvement from her son’s initial riding lesson experience. That is where they are afraid to get up off the ground. He just couldn’t…he would just go up and down that step and everybody else would be up playing and he would look lost. gate closed behind us. O. From that point on. he didn’t want to go down slides.. Rick could never go past that porch.” And you hear Rick kind of giggle. “Hey. is Rick up there with you?” And…[the other kids] said. he didn’t want to climb up ladders.? And so [her friend] hollered up that little tunnel and she says. in unison. he was just stuck. “Yeah!” And I hollered up and said. it was just very sad to see your little boy just go up one step and sit down. He…believe it or not had some gravitational issues. You know how there’s just a little porch and it goes up into the big thing. which speaks to the importance of motivation to conquer these physical fears: It’s just been amazing. And he has never. he could…and it was only after he had finished his first full horseback riding session…that was the first time and he just started being able to do more physical things.

parents 85 . Even though many children in this study receive physical and/or occupational therapies in addition to therapeutic riding. and like I said the second pass around the gate I heard him say. And that was one of our biggest issues with…his sensory issues were that he was so afraid to be up off the ground. but after he got going. “Walk on. I didn’t think she was going to get him up there. “Walk on. somehow Denise finally…said.” …Mikey was his first horse because I remember him saying.” And she did. it was O. And that took…weeks and weeks to get him to do in a gym. And once she did.…I almost…don’t even notice it really anymore…he now just goes on climbing structures and slides and I’m sure this has a lot to do with it because there was a time where…he wouldn’t even go down a slide. screaming.And so I had initially thought this is going to be a huge issue with him…But somehow he really just wanted to do it…The very first week…he was…clawing on Denise.”…And after the…first couple weeks he still was a little afraid to get up. walk on. And so now…you know it seems to be resolved.K. once she did it was smooth sailing after that. And then. Although improvement in gross motor function might eventually occur in lieu of targeted interventions in children with ASD. “If you just trust me and you walk away I’m going to be able to get him up on this horse. the typical reluctance of these children to participate in normal play and physical activity invites an emphasis on appropriate organized physical activities for this population. “No! Help!” And I was standing there. Yeah. So I thought. Mikey. He just got on and rode and. “How is she going to get him to do this?” because his PT could barely even get him to go up a ladder to get on a slide.

The process of socialization begins soon after birth and continues through exposure to a variety of roles and interactions as the child matures (Edelman & Mandle. Social competence requires skills and abilities that allow a person to interact effectively with others in diverse societal situations. The only thing I can figure out is because he’s concentrating too hard on staying on the horse so he can’t argue a whole lot!” Social benefits. maybe just a…it makes them forget. I mean…he’ll do stuff easier on a horse than he will if we’re in here and I’m telling him to. & Yakimo. she replies. and compromise (Murray. and I’m like. 2009). And since it feels funny anyway. 2002).” And he’s going crazy on this horse. Children become socialized through opportunities for collaboration. And he could get on the horse and…do all this crazy stuff. “Yeah. “I have no clue. begins to 86 . “On the ground he can’t do that. Zentner. they don’t realize… Bob’s mother endorses this theory. “Oh I can’t do this”. or self-recognition. So it’s definitely a. Infants going through normative stages of development in the first year of life will become attached to their caregivers and will begin to recognize and respond properly to the emotions of others (Berk.” When asked what she thinks causes this. and now look at him. 2004).such as Kerry’s mother commonly referenced the enhanced motivation to participate and resultant compliance that is provided by this program: …you know he had problems with his balance and crossing things…and he would get on the horse and he had beautiful balance and he could throw things and…they ride bareback. cooperation. A sense of self. and appropriate socialization can play a crucial role in an individual’s future level of functioning and positive mental health. competition.

2002). accurately perceive social cues. his ability to interpret and react sympathetically to the emotions of others marks the development of the characteristic empathy that is fundamental to positive interaction with others. Children who do not experience this group attachment are considered at risk for rejection and loneliness. As the child matures through the pre-school age. his self-identity is strengthened through participation in cooperative exchanges with other children. 2002) increases as the child learns to understand the roles of others. as the child begins to transition from reliance on family toward increasing independence (Berk. particularly through joint interactive and make-believe play that allows him to practice taking the perspective of other roles or imagined personalities. siblings. Peer relationships become increasingly significant to personal development through middle childhood and adolescence. 2004). plus gradual exposure to group situations provide a basis for development of self-esteem (Edelman & Mandle. Social sensitivity (Edelman & Mandle.emerge as the child recognizes that his actions have predictable effects on those around him. During this period there is a natural tendency for the child to strongly identify with a selected peer group or clique and adopt the values and behavior standards modeled by that particular group. caregivers. 2004). and take part in reciprocal verbal communication. Strong relationships with parents. and friends. the degree to 87 . As peer relationships help form a foundation for future interpersonal relationships and bridge the gap between childhood and adult social roles. The ability to interpret and understand the emotions of others and consequently predict or alter their behavior motivates positive social behavior and allows for the development of early friendships (Berk. As the child matures through the next two years.

cooing. and the child may not 88 . Depending on the age of onset for symptoms. which forms a basis for controlling inappropriate behavior and understanding the world around him as defined by his particular social setting. Continued progress in social speech is affected by the amount and quality of the child’s interpersonal experiences. 2003). indications may be observed in infants who do not exhibit a social smile. Language development has been previously discussed earlier in this chapter as an aspect of cognitive processing. Attachment behavior may be impaired. or normal eye contact (Sadock & Sadock. Continued speech and language development is dependent on environmental stimulation and reinforcement as the child matures and progresses in both comprehension and expressive language. Effective communication involves not only correct usage of language but also of social speech (Murray et al. During the toddler stage of one to three years. body movements. anticipatory posture for being picked up. facial expressions. the child begins to learn to communicate in an understandable manner. babbling and assorted other sounds. but will be revisited here as a feature of social interaction.which a child fits in is a powerful determinant of healthy socialization (Edelman & Mandle. as well as crying. Lack of appropriate social interaction is a classic feature of ASD. 2009) that requires an understanding of the perspective of another person involved in conversation. and other nonverbal behavior (Murray et al. Most children produce their first recognizable words between 10 and 18 months of age and have a vocabulary of at least six words by 12 months. 2009). Communication involves not only formal spoken language but also vocalizations. Infants communicate through eye contact and facial expressions and gestures such as reaching. 2002).

As the child matures. resulting in a lack of the empathy and ability to correctly interpret the social behavior of others that is so critical to successful social relationships. doesn’t fit into a group. Many of the archetypal features of ASD -. “…he isn’t really good at playing with kids yet…I’ll ask him about school. 2003). who his friends are. He’s a homebody. Four year-old Gary’s grandmother remarks. Examples of social isolation. has few friends. These factors can effectively cripple any efforts on the child’s part to develop friendships or fit into a peer group as he ages.child prefers to be alone. and by all staff and family members interviewed.demonstrate a strong affinity for his primary caregivers. although deviance from his standard routines may produce stress. there is a typical lack of ability or interest in interacting in play with peers. He doesn’t have any. is uncomfortable in social situations–would be considered warning signs of stress in a normal child (Murray et al. 2009) and potential precursors of emotional health issues. and he is characteristically incapable of taking the perspective of others. References to social gains through participation in the therapeutic riding program were made in all three focus groups. spends excessive time in front of the television or computer. You know…because he has so much stimulation at school all day because he’s going a 89 . approximately 50% of children with ASD will never develop useful speech (Sadock & Sadock. Comments made by family members in the current study support this description of the social limitations of children with autism spectrum disorders across the developmental years. Communication issues range from language delay to language deviance.” Steve’s mother describes the self-imposed isolation of her 16 year-old son: Steve doesn’t like to get out of the house.

Jim’s mother has witnessed many different stages of her 23 year-old son’s complicated social development: [He]…doesn’t like being in a situation where he doesn’t know what’s going on. So this [riding at CKRH] is really his only source of…socialization outside. Increased social opportunities and interaction. He couldn’t handle birthday parties. yes… From her dual roles as the mother of a child with ASD and a pre-school teacher. adults that 90 . as illustrated by volunteer Jo Ann. although he’s very gradually making real tremendous progress with that. And to tell you the truth. yeah. he needs that time to chill and be in his room. even his own…we’d try to give a birthday party for him and have to take him home…he’d be the only one not there. But at the time…there were so many places we couldn’t take him. where it’s a new situation. And so by the time he gets home at night. the better it’s been for him…but the reality is with him. Jim’s mother comments with a broader perspective on the negative consequences of the typical social isolation of children with ASD: …I try to keep him busy and going and doing things. “There’s all sorts of social interaction with people their age…other children that have disabilities. and I find this with so many of the other—I work with kids with disabilities as well—that social isolation tends to exacerbate their problems.full day so far this year. The therapeutic riding program provides opportunities for increased social interaction in a supportive environment where children with ASD are encouraged to interrelate with others. the more of that we can do with him.

And he’ll just come up to them and start talking to them whereas…two years ago.. he knows by sight almost all the sidewalkers. or the [horse] leaders. “His biggest challenges are in the social area. social has surprised me most of all…because he has created. but all of a sudden…in the past two years we’ve come down here and he’s made such huge changes since we’ve been here that it’s just unbelievable.” This is a critical objective expressed by Brian’s mother. or he has gotten such a bond with Jo Ann…and he knows.” Jerry’s mother has witnessed progress in this area during her son’s time with the program: …I believe socially. Steve’s mother also appreciates the safe haven CKRH provides: 91 . Although gains in social skills may certainly result from a variety of influences as the child ages. Not only with the other riders. if not by name. but also with the instructors.” and Kerry’s mother.I don’t know if it’s just because everybody’s been so friendly and they talk to him and it’s getting him out. Wayne’s mother has witnessed obvious improvement in her son during his participation in the program. There is no fear. he’s going to be more overwhelmed. Jerry has come a long way…obviously…being social was one of Jerry’s biggest downfalls. which is part of autism…but he has made friends. When asked whether she expected such progress in social interaction through his riding lessons. she responds: Actually. that wasn’t [possible]. or if it has something to do with him going to school… and being mainstreamed now…I’m not sure where it’s coming from. He’s going to be a little bit more overstimulated and that’s how he reacts to most things..don’t…I think it’s good. Jerry thoroughly enjoys coming here. “And so in social situations.

I can get him out of his room some. During the first volunteer focus group.. So to come and be able to get that confidence from people here. volunteers. Steve. So the social aspects of it has been really important…And…I really credit this program with a lot—with the majority of it. a lot of the kids have that problem socializing with the other kids…And so he’s not accepted by his peers that much. as described in the second volunteer focus group: 92 . and riders. but he basically spends most of his time in his room…The social skills…has been a big thing for him because there have been periods of his life that this is the only place that he really socialized with anybody. And then it’s just a different atmosphere and…he’s old enough that he notices girls and stuff.. Jim’s mother finds the social aspect of the therapeutic riding experience valuable for her son who. so…he’s a lot more communicative and you can find out how his day was at school and things like that…but…he’s just socially inept in some ways.He’s had a hard time at school. including instructors. like many children with ASD. I guess is the best way to put it. He always has…having Asperger’s syndrome.I think that is helping him maybe socialize a little more. prefers to spend much of his time in his room: …when we’re at home. felt comfortable enough in class to communicate more freely: . Class activities are designed to encourage interplay between all participants. Alex indicated he felt that his client with Asperger’s syndrome. in terms of making him more comfortable being around people… Adolescent clients with ASD face new challenges as they become interested in the opposite sex.

and it seems to be an easier thing at the end of these two sessions.they have to…be willing to work with people because they’ve got a leader and two sidewalkers and a ring full of kids…And the horses. I’ve seen that they’re much.Perry: I’ve seen a lot more interaction between the kids themselves in this last session. and he’s very good at following whatever you tell him… but you know. and more of an awareness of this person that’s also there with them. Most of them are the same. Sherry: But some of the exercises. including one client who rides without the aid of sidewalkers next to him: Shirley: Well…. So I think it’s great. Perry: And I think…part of that is like I work with Mary…she has them waving at each other as they’re…on the horseback. There’s no sidewalker with them. Volunteers in the first focus group conveyed similar observations from riders in other classes. So some of them are just finding it much easier to reach this over and give it to so and so. more so than I did in the first session. he doesn’t really have a lot of interaction with the others. Alex: Well mine’s a little more—rides more independent. uh huh. Margi: Are these some of the same kids? Perry: Some of the same kids. becoming much more aware…of their team members …that are in there. 93 . Jo Ann: A lot of them. where they’re passing something to each other. and greeting each other…I think that has helped with that.

and…I noticed that he seemed to be able to keep him focused. than I remembered him being able to do. I mean. people he didn’t know. more. but Executive 94 . used to. Barb: So there were some people he knew. Hundreds of attendees plus live music contribute to an atmosphere quite unlike that of the regular riding facility. he was in a different environment entirely.Shirley: But…his interaction with people in general has increased in the last probably two or three years. Such a deviation from the regular therapeutic riding routine could prove to be an insurmountable trial for a client with ASD. and some people he didn’t know. he wouldn’t talk at all. Denise: And that was a situation that was not in the lesson environment. Eight riders are carefully selected to participate each year from the large pool of clientele. especially in a social situation like that where there were a lot of people. it was purely a social party setting. Barb: Yes. I saw this student and his father at a party that we had back in the summer. but it was a party! Each summer CKRH holds a major program fund raiser at Keeneland Race Track called Night of the Stars that includes a simulated auction of costumed therapy horses and clients. exactly. Deb: That’s really neat to know that. It was a party–it was in a barn. and now he’ll talk. Rick’s progress at a social event sponsored by CKRH was noted during the instructor focus group: Barb: Well.

Director Pat describes successful outcomes based on retaining some reassuringly familiar aspects for the clients with ASD who are faced with a very new social challenge: …we have had surprisingly a couple of our autistic clients that have participated. Clients are regularly encouraged to communicate in an appropriate manner with their class volunteers and instructors. so we’re continually focused on that eye contact…I think sometimes we forget. besides increased rider safety and stability. “O.. actually. when we’re working with the pre-schoolers and smaller children..” One other useful consequence of having the sidewalkers located in close proximity to their riders during a lesson. as Denise reports in the instructor focus group: . Increased communication. appropriate 95 ..I think some of this is just a matter of logistics. Increased eye contact. He would not look in your eyes... efforts are made to attain the reciprocal eye contact so often lacking in these children. when he was about a year. is the greater opportunity to meet their gaze. And although it was really something that could have gone either way…we were very fortunate and it has always gone…in the way that one might expect…I think it all has to do a little bit with expectation sometimes and knowing the child and it’s the same horse. we’re not always on their [level]…we’re not down here talking…but…when we’re talking about social interaction.He would turn his head away. Especially with nonverbal clients with ASD. he couldn’t look at you.K. but it’s kind of neat…documentation shows that individuals with a diagnosis of autism…have trouble making eye contact. the same people that they ride with. as described by Gary’s grandmother.

Eyes. That was huge. and he actually gives us better eye contact…we can say ‘John. when they are receiving directives.’…And he touched the mini’s eyes…That was huge. “…I’ve seen her make eye contact a couple times. and actually.” She also noted the same client had made some apparent progress in reacting to a classmate. John’s aunt has noted improvement when soliciting her nephew’s attention. well. ‘Eyes.communication. one of the initial signs of the autism was a total lack of eye contact. 96 . hopefully. if we have some level of matching [height] with volunteers – they’re at eye level. Denise recalls quite a unique experience she had with Robin. ‘Oh look!’…because her whole face lit up. listen’…and he’ll look at us…Like he…is understanding more…” During the instructor focus group. I know it did transfer over to humans. and actually give a smile. the person is right there – most times. It’s not a struggle to [meet their eyes]. a real smile…she smiled at something another rider was doing and you could look and say. at his early age. they’re at eye contact. “…we just saw…a greater attention span after he started riding Socie. This child had never acknowledged. whose treatment goals included improved eye contact and age appropriate conversation: …one of the students…when he first came to the program…three weeks in we were working with a mini [miniature horse]…and all of a sudden he just…looked at the mini’s eyes…and he said. And in that case. “I mean she’s starting to look at me a little more when I’m sidewalking…she’s the young woman that wouldn’t even come into the barn. appropriate eye contact. so I think that’s kind of a side effect… Volunteer Sherry has witnessed such a result while working with Jan. that was life-changing for this individual.

the rider is always asked to make some effort to ask his mount to “Walk on” before the horse leader will begin to step off with the animal. Denise again referenced this story.. crediting Robin’s atypical fascination with the horse’s eyes as an important foundation for progress in other areas for a child who was initially fearful and overstimulated by the novel environment of the riding facility: That was…to my knowledge and understanding. He’d had a dog at home. Class procedures are designed to elicit conversation from the clients. “Those were not the first set of eyes. Robin’s mother noted an almost immediate improvement in her son’s verbalizations when he began participating in the program: Oh yeah. with respect to their current level of language capability.we built from that point and I do think that…as we continued through the process. and then we went to the mounted activities and started obtaining the benefits from the movement and things like that. which he had not wanted to do. Denise had no definitive answer. he’d seen the dog’s eyes.When asked to explain Robin’s sudden interest focus on the miniature horse’s eyes. he still wasn’t talking all that much. So with that connection then that motivated him to actually touch the horse.. He developed trust for the animal. oh it’s very positive. he did learn…to accept. the first time he had ever really identified eyes…other than a picture…and he looked into the horse’s eyes and he wanted to touch. And just learning to communicate with them because when we first came here at four. “Well–they’re big!” During her personal interview.” Alan provided a fairly simplistic theory. But 97 . For example. Why did the connection happen with the horse? I have no idea. Class communication.

he is more motivated to communicate his needs to those assisting him. ‘I have to talk here. That necessity for prompt toileting has inspired greater verbal efforts by Doug. ‘I need to go to the bathroom. So…it’s just been an amazing experience As Robin’s mother notes.’ I thought. ‘Oh my gosh!’ And so I was sobbing watching him on this horse. ‘Walk on. And then he started realizing. What they can and cannot do…if they have an issue. “…the social time was…to have to actually look at people and tell them his 98 . but…be able to give directions and communicate what they need.I noticed here he was really talkative. and I heard him say. like if they have to go potty. I have to tell the horse “Whoa” and “Walk on”…and so…it really motivated him to talk and have conversations with people. Wayne’s mother notes. you know. if the child has a problem or concern that requires attention. which has been an issue sometimes…they have to tell us before they have an accident. first of all. “…one day he just turned around and looked at me and said. actually talking to the horse and to the people and doing what they want him to do. because I didn’t think he was going to do it.’…clear as a bell…But he usually wouldn’t give you full sentences. he came around the ring and he barely talked to anybody other than us. And secondly. as reported by volunteer Shirley.” The individual attention each client receives from his team can compel the child to interact to a greater degree than in other activities in which he participates. And…one of the first times we were here. because I have to tell them if I’m scared. and volunteer Jo Ann agrees: It…forces them to talk to people and—well not really talk to the horses.

which Wayne’s mother feels has generalized to other situations as well: …what they basically play is Red Light Green Light. Instructors and volunteers often learn through trial and error how best to approach and motivate each client. but it is a group of kids. Like when the teacher says. And… he’s getting more vocal in like…not just talking…he can project himself now when he needs to. on like the nights that he’s not listening. Shirley: See…he wouldn’t do that when he first started riding. as discussed by Alex and Shirley in the first volunteer focus group: Alex:…with Dave I just kind of keep the instruction shorter.. “We’ll have to get off…” Shirley: He’ll listen. And he just loves that. Class activities often require verbalizations from the child.name and to ask them questions and to listen to the directions and get that kind of affect from it I guess. There’s not all that socializing going on because they go there. what you tell them. “What’s this say?”…he can 99 . And it’s neat because then he has to watch and pay attention and follow the directions. But when he can repeat it back to you.” A comparison to Robin’s gymnastics class is provided by his mother: In gymnastics…they’re working on…their individual skills. Alex: But you know. and then they practice the skill. We’d say it to him and he wouldn’t repeat—so that’s where you don’t know if he’s getting it or not. But there’s not all that communication going on. and then usually he repeats it back. the coach shows them a skill. if you stop the horse and tell him.

She’ll say “Whoa” and she can make a sound. And they get them to say…“Look John. but basically not much.K. …they’ll say.” and he’ll say. “Purple. blue and yellow” that day.. but not yelling…and he doesn’t yell as much as what he used to do. “Go.” and he’ll say. “Go. that’s great. and I think she said. “K.” and it…wasn’t perfect. And I thought. 3.” Volunteer Sherry didn’t initially appreciate the significance of her client’s articulations during one lesson: …One little girl that I’ve been working with for a while is nonverbal pretty much. “Walk on. But…they have a little one that matches each letter.” And Mom started to cry. “Well. Say K. 3. …and they do counting also.” And they stop Socie while they do that and then after he says it and he throws the letter down. because while I know she’s not terribly verbal. like the purple ring goes here…and I asked her what color she had and she said. John’s aunt illustrates specific lesson exercises focusing on receptive and expressive language skills: And they had these big letters out there now. She’d never said them before…And I was stunned. she said the colors.” And I didn’t think a whole bunch more about it…and she dismounted and went over to see her mom and I said.tell her even if he’s a distance away in a loud enough voice.” and say a few. She knows her colors. set” and he’ll say. I didn’t know she’d never said her—but she knows them. 2. this is a K. like A through K and I don’t know how far it goes up. “1. “That’s great.”… and he’ll go up to 10…And they’ll say.” Or. 100 . “Ready. “2. then they go.” and then he’ll say. 1. “purple. And we’re doing a matching up. but it was obvious what she said. “O.

clients must learn to communicate with their horses as well. You tell him. regularly coaches her son through his frustrations. Talk to him. The ability to accurately interpret nonverbal communication is essential for a safe and successful relationship with the non-speaking horse. “He’s listening. ‘Hey. which involves utilizing both verbal and nonverbal cues. “You’ve got to talk to him. realizing the additional challenges and rewards this can present to a child with ASD with compromised communication skills. “Oh it’s so hard. and I…really think that…riding has just really made him maybe become a little bit more aware of those things. let’s go…walk on. emphasizing the use of both spoken words and body language: …and he’s learned.” Nonverbal communication with horse. Like we’ve talked about [Kerry says].” And then your nonverbal commands. but perhaps especially so for clients who typically 101 . And he’s like.Executive Director Pat has witnessed successes for verbal clients with ASD who have greater problems with inappropriate speech. In order to hone their riding skills.” And I’m like. which is also something that…he doesn’t pick up on well…but it’s getting better with that. Kerry’s mother.” And the communication thing comes in because he’s got to…communicate with this horse. He’s listening for those.’ You give him his commands. “…things that I have noticed myself…for children that have inappropriate communication disorder…as part of their symptomology…they have really…benefited greatly. This can be a daunting task for anyone unfamiliar with this animal. “Well how am I going to communicate…how am I going to tell him?” And I’m like. …sometimes I pull and pull and the horse won’t turn.

but I also think it’s partly the fact that he’s comfortable here and…these people are into horses for the most part. horse backing from you?” And a gentle way to come up to them and approach. Jim. ‘Oh please. “And he loves talking horses with people and…So I’m like. which helps…[the clients] a lot in their approach to people. and like to talk to him about horses and…they’re teaching him about horses. How can you approach your horse and make your horse look different? Can you get rid of these things on your horse’s face? You know. Jeanene.’” She credits one volunteer with making a special effort to cater to his somewhat obsessive interest in horses: …when we first came…his speech was pretty much…one syllable answer…“Yes” he will. what is that telling you…in your approach? Is this loud voice…[and] running right up to their eye and waving your hands…is this a happy sign?…look what your horse is doing. in particular.lack this capability in human interactions. has spent a lot of time teaching 102 . I’m dying here. it’s backing away from you. ears back. Three parents noted the additional motivation for their children to communicate with people who share their love of horses. Jim’s mother. obviously.” or…just follow instructions and now…as he’s gotten older…and partly his communication skills have increased. Its ears are back. Eventually that translates into… “Do I run up and get in somebody’s face and scream and wave my arms?”…So…I think a lot of that is just a life skill. don’t talk about another horse. Executive Director Pat recreates typical instructor dialogue designed to help clients determine the correct interpretation and proper response to equine body language cues: “Look at your horse. or “No. it’s looking at you. does not share his interest. unfortunately.

do you go riding?” “Yes. Kerry requires a bit more prodding: If someone mentions it to him. “…another thing…that is so hard with kids with autism is to make friends. So he loves it and he thinks he’s big stuff. He’ll tell people that Socie is his horse. And so here he is with people who have this common love of horses. I go ride Socie. And I think he said something about. Even wanting to communicate with people. I don’t think he would ever initiate a conversation about riding. “Bob.”…He does talk about it away from here. And he responded really well. And just even communicate with people. Jerry’s mother responded. 103 . if someone’s talking about horses or…I think he was with a speech therapist and she had some little horses. but if it comes up.” According to his mother.” And then she was able to ask questions about Zippo.” The researcher questioned whether these horse-related conversations continue away from the CKRH facility. [Although he] Beat the fire out of that horse…you ask him. Despite initially being quite physically abusive to his mount. “I ride Zippo…Zippo’s my horse and I take care of Zippo.him about horses and spending extra time with him and…he’s just eaten it up. Robin’s mother views this shared interest as a basis for forming relationships. He loves it. “…when we get home… he’ll have his riding helmet in his hand and he will tell every neighbor that is outside…that he was riding his horse. Bob’s mother reports his consistent desire to chat about his horse: …you know from the get-go…we left the evaluation and he talked about Socie.

Jim’s fascination with horses doesn’t stop when he leaves the CKRH facility: He talks about horses nonstop…well that’s a big obsession. We don’t have a barn. If the horse is not getting the cues…it takes both of them to communicate with each other to make it happen. learning to properly lead the horse. Being able to recognize and predict the effect one’s actions will have on another is an essential step toward taking part in appropriate social interaction and developing relationships. but that’s his thing…And his room is the farm office…he’s gotta go home and go to the farm office…So he’s…very into the horses.” But we don’t live on a farm. it doesn’t happen. Learn how actions affect horse. Executive Director Pat provides an illustration of the typical progression of the learning curve: 104 . Deb: Instant feedback Denise: Instant feedback is a good word. In some cases. this human/equine interaction begins with the client on the ground. they are a team…unlike a dog.. if the rider’s not riding the horse and telling him what to do and giving him his cues and everything. or a cat. as discussed in the instructor focus group where the concept of receiving and interpreting feedback from a more complex being is also introduced: Alan: Plus. It’s his only real conversational piece…because we can still ask him things about what he did today…and he always ends it with… “And I came home and found a horse in the barn. the two of them make a team. Therapeutic riding clients must learn to work cooperatively with not only their instructors and volunteers but also with their mounts in order to become more skillful riders. We don’t have a horse..

they’re going to hold it the furthest point down so they’re really dependent on the mini to sort of… Margi: To lead them.Pat:…some severe autistic clients lead a mini. They’ve learned how to use their control to affect that horse. Kerry’s mother reports the importance of developing an appreciation of the horse’s ability to read the handler’s nonverbal signals as well: …and I think he’s finally started to get that connection too. Pat: But when the mini decides to go this way [indicates mini moving away from the child]…at some point they need to make the choice to let go and then they have a loose mini…and everybody goes and catches it and tries to teach you. But then over time…you’ll look out there and you’ll see and the same children…walking with the horse. Just sort of wandering around…not tuned in. And you try to get them to hold it correct. But I think after a while he started making more of a connection. and they are oblivious to the fact that they have just turned a horse loose. “Hang on to it!” or try to figure out how to negotiate what will make that mini stay with them better. And so sometimes…they go out together and they veer off to a ‘V’ and everybody’s chasing the loose horse. which we sometimes do…you put them on the shank with a mini…and they’re going to hold on to the lead line at the furthest point down so they have no real control over the horse. Because he used to just get on the horse and it was like something he rode on. but left to their own. which I really wanted him to do because sometimes it’s hard for him to make that kind of…connection…with 105 . They’ve learned to control themselves a little bit. and they’re clearly in control of their horse…it’s a skill that they’ve learned.

” Rick’s father volunteers as a sidewalker in his son’s class.” because he’s…[Margi: He’s not just a car.] Yeah. “Well yeah. “He’s paying attention to you and he knows if you’re…nervous.” You know…sometimes the horse is not so happy… Fit in as part of a team concept.people. he is?” And I’m like. which is a significant step toward forming interpersonal bonds. Like push the button. animals…because their communication skills are so awkward. and…I’ll just kind of accept it”…but now…he’s very much in with the group of people that he sidewalks with and the leaders and stuff. because they even told him…“You know when you’re on that horse. and not very skilled…but…I think he’s finally starting to make more of a connection. “Oh. The therapeutic riding facility is cognizant of this need. being with your team.” And he’s like. “Oh. or he knows if you’re happy. that horse’s ears are turned back and they are listening to you and he’s waiting for your command and he’s waiting for you to move”…and he’s like. It is common for children with ASD to miss the experience of being an accepted member of any type of group outside of the family setting. “We work on that as well. as Deb responds when asked to address relationship building during the instructor focus group. watch his ears. He’s constantly listening and wondering what’s going on. I think it’s all part of the social interaction that we’re looking to provide…being with other students. He’s 106 . Yeah. with horses. exactly. but he has purposely avoided working in his son’s team during the lesson in order to encourage more direct contact with less familiar program personnel: When we first started out…from his standpoint…it was more of…“You’re going to have to be there.

there would have been no motivation. such as the potentially uncomfortable sensory experience of placing one’s hand into a bucket of sand: Denise: This child would have never have done that if he hadn’t been on horseback.. I wanted…to help bring up social skills. Sitting in a therapy room. it’s your turn! O. another reason why I didn’t want to be with him. seeing all the other students do it. And getting him to reach in and touch sand would have never… Barb: Well. again. Night of the Stars.. that he can talk and be comfortable with other people…so that’s really helped as well.” 107 .K. it’s your turn. I think he feels a little more like they got a little group…and then doing the Night of the Stars kind of helped too…because…the little girl. It’s your turn.K. everybody go around. in physical or in occupational …which is where he would have been doing that. again.so from that standpoint. And this class has been good for him socially. Although children with ASD demonstrate a classic deficiency in peer interaction. Mary: And then seeing all the other students. with the other kids and kids his own age. Kerry’s mother describes the value of participation in peer groups through both the regular lessons and at the annual fundraiser. the blonde.very interactive with them…. “O. the instructors feel this concept may add to the motivational effect of the client sitting atop a horse when encouraging unwilling class members to fully participate in all activities. so that actually did help him… Members of peer groups are typically subjected to pressure to conform to group standards of behavior. she was in it…and…then Peter was the engineer and…so it was really exciting.

Mary recounts an example of her interaction with Jan that has helped the student progress toward mounting a horse for the first time. Rick’s father is mindful of the significance of this aspect of normal social development.” Clients frequently develop trust in their instructors. And… she gets on the Equicizer [a mechanical horse]…and…I think that…she’s built up a trust in me. Last lesson we had Annie [the horse] come in the mounting block so she could visualize the horse standing there. and is glad his son prefers not to use him as his personal sidewalker. I tried the first time and he emphatically said. so…I made it a specifically clear that I would be with another client…now this…session on Saturday…they wanted to put me with him. and she touched her. And that I would never force her to do something she wasn’t comfortable doing. That he needs to be able to…trust other people and that…other people can care for him as well.Learn to trust others. she knows…that I would never let anything…happen to her. 108 . following her extreme initial reluctance to become involved in any equine activities: …we very much get along…she’ll laugh…and she’ll smile…and I think we have built up a rapport…between the two of us…and…we have now gone…up on the mounting block. “No Daddy. which is crucial for continued improvement in their riding skills. even though he volunteers in the same class: I’ve never worked with Rick [when I am volunteering in his class at CKRH]…because Rick needs to know and at the earliest stage as possible that he needs to be able to count on other people and not just…my wife and I…or my extended family. An essential component in developing friendships is learning to trust another person.

Younger children often display no interest in interactive play with peers. can be a daunting task for most children with ASD due to their restrictive social skills. I mean. he’s not doing that in gymnastics. “…I know when…friends of theirs come over with a little boy his age. that’s something a lot of people aren’t fortunate enough to have. “Well Alan must really believe that I can do this.” Robin’s mother expresses appreciation for the social connection that is possible at CKRH: …of course. with autism.” And then he goes to Special Olympics and he wins a gold medal!…Alan believed that he could do this…and he transmitted that and he did it. He says. And he did it. he does. “I can’t do this. Form bonds and relationships.Denise describes a similar connection that Steve has with his instructor. Adolescents and young adults with ASD may feel a greater sting from a scarcity of friends. Forming relationships with others.” And she said. he doesn’t really play with them.” and he goes back to his mom and he tells his mom. Alan who encouraged him to participate in the Special Olympics: …when we approach this individual [Steve] about…entering Special Olympics and he was really nervous about the pattern. to see their child form an attachment and a friendship and a relationship. as Jim’s mother conjectures that his occasional aggressive behaviors may be a 109 . especially outside of the family structure. I think it’s because there’s not— the opportunity is not really there…here it’s a constant relationship that he’s really fostering. “Yeah. as Gary’s grandmother notes regarding visitors to the parents’ home.

even though she’s very nice…” With instructors. Substitutions need to be made on occasion. much more responsive as far as following her…to pick up the rings and… Shirley: And some of the volunteers are more assertive and some of the kids like men better than women… Kerry’s mother senses some disruption on a day when there has been a substitution. Parents or family members of 13 of 15 children reported strong bonds formed with their riding instructors who commonly would be their most consistent contact over 110 . which may cause a break in this continuity and potential problems for the client. And I think it’s throwing him off. Then with the person that was usually there.” The riding facility personnel are very cognizant of the need to match teams of instructors and volunteers to each client. “…today he doesn’t have his usual sidewalker. as discussed during the first volunteer focus group.consequence of his communication difficulties and “…also his frustration at only having one or two people in his life. based on personality and individual needs. but can also reveal additional effective combinations and provide expanded contacts for the child: Shirley: Some [combinations] just doesn’t work… you try to have a team but you’ve got people that don’t show up so you do swap your volunteers around and then with that. I’ve seen a reaction from one of the riders when she had a sub. I mean we all need a little more than that. sometimes you…hear somebody go…“Oh I loved working with…” Sherry: …Yeah.

“And this is my other dad. …they’re very involved. “…He really likes them and they actually sidewalked at the gala so he remembered them…he still remembers them from helping him…” John began the program with Suzanne as his 111 . “…my observation here has been that she really doesn’t give anybody else much mind. they get them together. and she’d say. according to his mother. She pretty much focuses on Ms. what’s going on?” So. I mean that’s knowing your kids…And in between sessions. They still like that interaction…the personal interaction with the kids.time in the therapeutic riding program. at least.” Jan’s mother explains that the degree of comfort the instructor has with clients with autism is crucial. is going on…She likes Marsha. an observation confirmed by team volunteer Sherry. “I think…Jan reacts real well to Mary and relates to her.” Meghan’s grandmother depicts the special relationship her granddaughter has with instructor Marsha and her husband. and are linked with his positive memories of participating in the CKRH fundraiser Night of the Stars. and…Marsha can pick up very subtle differences. She’ll say. Although her step-mother feels she has “pretty good social skills. but I’m not really part of her focus. that was good… Marsha and Tim are also favorites of Dave. Mary. And I don’t think she hates me. Meghan called Tim her other dad…this was several years ago…we’d be standing there together. who assists with Meghan’s class. however. Mary. “Something’s just not right with Meghan tonight. Tim. Tim”…in her way. She has. Like we just had a bowling and pizza party. She likes Tim…well as much as Meghan ever interacts…But for a long time. established a strong attachment to her instructor.” Jan does not relate very much to her class volunteers.

degree of direct personal contact. for a year and a half. Wayne’s mother says he has been fortunate to retain one of his sidewalkers throughout his experience at CKRH. And he got used to her and her instructions. Suzanne’s the one who worked with him the most. and the child’s level of social maturity. He knew what she wanted of him… With volunteers. dependant on variables such as consistency of team makeup. And she was very patient with him. “… Jo Ann has been one of his sidewalkers the whole time…Since the first spring that he was here. so she’s been with him for six sessions now. she’s only been doing it maybe four or five times I guess. And…so I’d say that was…a plus. His aunt mentions the challenge of adapting to changing personnel: …well now with Denise. such as horse leaders or sidewalkers varies.” Program Director Denise suggests an additional rather simplistic factor which might be associated with the relationship with the sidewalkers: Now what I do see is more social interaction with their sidewalkers if sidewalkers are applicable…one thing that I think affects that is just pure logistics…if a child is sitting on top of a horse and the sidewalker–they’re closer to face to face than if a child is standing and the adult is standing…Making sure that when I’m talking to an individual…and they’re not on the horse. The degree to which a client relates to his class volunteers. that in some way we’re on the same level—literally—to give them the opportunity to make eye contact and to reinforce that… 112 . and they had a very good relationship.instructor but is currently transitioning to Denise as his new teacher.

Don. And I thought. ‘Hi. her name’s Julie. And just even communicate with people. He still talks about her. Even wanting to communicate with people. Kerry converses actively with his regular sidewalker. as John’s aunt notes. “…Carolyn’s always been just wonderful and she always takes the time to say.” And he really 113 . “This is the first time he’s had a relationship with another adult that’s not my husband or me. And then he remembers Carolyn. John.Really. “Mr..Clients tend to become attached to volunteers who take the time to recognize and converse with them. And he really wants to please him. are you happy? Are you happy?” Because Robin would do something and Don said. see you next week’…that’s important to me…that people recognize him…I like that. John. Don. And he’s establishing relationships with them and he got very close to Don. according to his mother. how are you?’ ‘Bye. very fond of him.. And so I can remember so many classes where he would lean over and look at Don and say. And so here he is with people who have this common love of horses. that was another girl that was a sidewalker from last season. which is the guy helping him now…he says ‘Hi’ to him when he brings the horse up. he loves her…very sweet… loves to talk to her…” Robin’s mother describes the significance and depth of the relationship between her son his sidewalker which is based on a shared passion for horses: …[it] is so hard with kids with autism is to make friends.” Dave’s mother agrees: …well we’ve switched nights so we have some different volunteers. “…he usually has this really sweet girl. but…he likes Alex. “Way to go Robin!” And Robin would want to make sure he was making him happy and pleasing Mr.

” And I thought. but several parents reported some instances of interaction with peers. With classmates. Jean is another little girl that’s out there. but we don’t really know anything about horses. that Jean came up the other day and they hugged…most people think that’s crazy. the children do not come into as much direct contact with their classmates as they do with their instructors and their team members. Meghan’s grandmother was pleasantly surprised to witness this incident. so it’s not like we share this bond that he has and this—of course we’re interested. During group riding classes. And that was just an amazing thing to see. this relationship that developed between Robin and these sidewalkers and his instructors and…just making friends. which was encouraging to me.wants to please him…my husband and I don’t know anything about horses. That’s good”… Dave’s mother recounts her son’s happiness at discovering a school classmate in his riding class: And he knows JB from Rosa Parks so that was really exciting when he first came and saw JB here…And he just started riding again last session…And then he…was excited when he saw JB again because JB is going to a different school now…so…that was kind of good. Don and I think he wants Mr. but for an autistic child to actually hug another—and [Meghan]…said. And I noticed. especially considering how reluctant she is to hug family members: Now. Jean. “Oh yeah. and here Mr. So I guess there is a little bit of social…they 114 . Don knows a lot about horses and he respects Mr. Don to respect in turn. “Hi.

So I don’t think he really connected with them. riding skill and age group.. Kids 115 . sometimes he’d…be with teenagers. And…that was fine but…now…he’s kind of made some friends. I think it lasts for a good long while.don’t sit around and talk about it. but…he sees and says “Hi” to him and he says “Hi”’ to his dad. he was like five and everybody…and everybody else was like. But on the weekends they might hang out…It does happen. which was fine by him…because he liked the sidewalker and everything. He talks…“Hey there’s so and so. as Kerry’s mother relates: Now this class has been interesting because… [there are] More kids all his age…because…sometimes you’d be with adults. like the youngest…when he first started. And certainly when it does. He recognizes his brothers and sisters and.” and…then we’ve done a couple of fundraising things with a couple other children. Executive Director Pat has observed the formation of lasting friendships among CKRH participants: And in some instances…the children end up being the peer groups outside of the program. scheduling limitations sometimes prevent the ideal mix to encourage peer interaction. We have a couple of those that…formed a bond in riding class and because they’re the same age and have the same challenges and probably are lacking for friends in their immediate environment outside.. you know that’s all nice to have somebody that you recognize that comes back to your sessions… Although care is taken to match children in group lessons relative to their levels of disability. I think the youngest was 17. they’ve kind of formed a peer group that started here so they ride together but they might not go to the same school together. And he would be.

therapeutic riding adds the potential for clients to bond with the program’s horses as well. in fact. Promoters of this type of intervention feel it is. Denise: And he reacts to them. Alan: And they know. I mean the students know that. didn’t they go to the same college when they got out of school? So I think they were roommates. 116 . “…I think…for the autistic…children…just the awareness of the interaction that they have with themselves and their horse…it’s interesting to watch some of them. the presence of the horse that enables clients with ASD to progress in this unique environment. as discussed in the instructor focus group: Alan: …The horse is living. It’s got a will of his own. Margi: [You can’t just]…push the button. I think we had two of them that. sure. and they figure that out pretty quick. While enumerating the range of benefits the program can provide. Barb: And you…get out of what you put into. it’s a living thing. Executive Director Pat pointed out.” Horses are adept at reading the nonverbal cues of their handlers and providing immediate feedback for actions directed at them. While social skills are typically assumed to involve interaction with humans. which challenges the client to supply appropriate behaviors toward the horse.[to make the horse go] Denise: They get reaction back. Barb: Sure.will get along and ride and they come together a lot through CKRH. With horses.

I mean it’s the fun of coming out here versus going to do something else. “…I think he likes all the horses.” Variability among clients. “I think the kids can sense when the horses are not having good days. Sherry: Yeah. some of that may be tactile too. while Dave’s mother notes. Shirley: Well. as described in the first volunteer focus group: Sherry: …I’ve gotten riders that some of them are petting and hugging and kissing the horses. I don’t know that he has a special bond with any one horse…” Brothers Doug and Brian have differing levels of involvement with their mounts.” and I remember after that event. Some riders favor the mount they are regularly paired with. according to their mother: For Doug it’s the activity of riding…for Brian it might be a little bit of the horse…he rode a horse named Annie for his Special Olympics and…so he was…a little bonded… with her. The degree to which clients relate and bond with the horses varies. he wanted to go back to the barn and see her and pet her and…we took pictures with his medal and everything… 117 . and other that just don’t really—they’ll give a pat if you say…something…that doesn’t seem to have made a… Shirley: Bond.Volunteer Jo Ann has observed clients displaying some degree of empathy for their horses. I think every rider I’ve had appreciates the horse. I mean it’s kind of like…“She helped me…be successful. there’s just a magic about the horse. they like the riding. but it hasn’t…yeah. Alex: I don’t know. Alex: I was going to say.

not so much for the people.” From initial fear to bonding. Denise then recounts lessons which involve some degree of non-mounted contact with the horse prior to the riding session. And she’ll say. pre-tacked. and they bring a horse into the mixture and he’s like. but for the horse. But he had the separation anxiety…socially. For those individuals. he didn’t want to be around a group of strangers…so he had so much anxiety. “Can you give Socie a hug?” Or. it’s in the ring waiting on them. he couldn’t wait to come back. as Jerry’s mother relates: …I think he was a little intimidated the first day we ever brought him here.. Children must occasionally overcome an initial fear of the horse after their first encounter. 118 . “Can you tell Socie bye?” Or.Denise suggests that differing amounts of pre-riding time spent with the horse is one factor that can sometimes explain this client variance: …the social aspect of it—what we provide—really varies…There are certain situation…such as…where the individuals come in. After being “terrified of the horses” at first.but after that. I see less of the bonding with the horse.. they walk in and they get on their horse and ride. “This is not right.”…and it was a horrible hour. now he’s got so…sometimes they’ll stop Socie and then they’ll get him off…at the end of the session. “Can you give Socie a kiss?” And he actually. their horse is pre groomed. “In those cases. and they brought the miniature in. I saw more interaction—more social improvements than I do with those who do not have non-mounted activities. John’s aunt reports witnessing displays of affection for his lesson horse: Oh.

importantly. When asked about the presence of the horse in the interactions with the children. it takes a while for them to get adjusted because I’ve switched horses and kids a couple times and they get real confused or real sad… “Where’s so and so?”…They really like their horses. “…he rides Socialite. I used to call Zippo a ‘him’ all the time and now he corrects me and 119 . he would say. He wanted to do that. And I saw him outside of this setting. like on the drive here. Socie. And we’ve been with Zippo for almost a year. If you change horses on them. but he said his very first horse was Socialite.” or her. who’s your horse?” [Bob replies] “Socie. Mary.one day he broke loose from her and ran over and just hugged Socie himself. has noted his allegiance for his mount. I think. Bob’s instructor. and he would talk about. and of course he was very excited about Socialite because that was the first horse he had ever been on.”…that is his horse. Volunteer Jo Ann remarked in the focus group: Well. “…Zippo really wants me to get him out. so he really got attached to Zippo. And then we moved on…to Zippo. “Let’s go see Merry Legs. Children like horses. hi.” her father recalls. and that is his horse. has exhibited the ability to view his and Zippo’s relationship through what he imagines is the horse’s perspective: He really was fond of Zippo. how are you? Are you gonna come ride? Tell these ladies. they form attachments with their horses. Robin’s mother says he has ridden three different horses and developed attachments to all of them but. Jan’s first comment on the journey to the riding facility is often. “Well. without being instructed to.

“Zippo really wants me to get her out and she wants to ride today. When asked if her son has a special relationship with any particular animal. therapies or interventions for children with ASD would not offer the type of opportunity therapeutic riding does to learn how to deal 120 . Steve’s mother reports his strong affinity for the horse he has ridden the past two sessions: Oh.” Red gets kind of left out of the mix of things a lot of times… Parents appreciate animal bonding opportunities.” and so he was thinking about this relationship he had with Zippo and how Zippo was counting on him and…that was exciting too. I think he does…he really liked—he talks about the horses. his mother enthusiastically replies: He does. “Well I don’t want to do it.” And then we talked a little bit more about it and he finally decided that he would go ahead and do it… When asked if her son Wayne has a bond with his horse. Most other traditional activities. I don’t want to do it because we have this bond…so I don’t want to do it. “He’s a girl. That’s what he says…because when they told him that he was going to get to do Special Olympics but he wasn’t going to get to ride Justin…his first reaction was. “Hi Chico.says. And…he wants to come and see the horses and we drive by to go up to Indiana…we pass by here. And…he still talks about him. If Justin doesn’t do it.”…So he would say. “Hi DeeDee. And all the kids wave to the horses on the way out…And it’s really a lot of fun. he has with Justin. so…He’ll sit there and he’ll go. And Red…he just loves them. hi Annie!” And now. A lot…Chico was the one he rode back last March…or a year ago March.

When speaking to CKRH instructors and volunteers. there is an emotional bond to the animal and I know from experience what horses can do as far as…relieving pain and things like that…I think that there’s this mental connection between the horse and the rider—the client—that it’s not only a physical rehabilitation. but it’s also the mental and emotional. “…I tell them. a concept regarding the magic of the horse is frequently mentioned that describes some indefinable equine quality that promotes a special bond with the client that cannot be duplicated by another human or animal. And I tell them how John was when we first started. you’ve got to check this out. Perry expresses this viewpoint that stemmed from personal experience during recovery from an injury: …I think…even beyond the physical aspect of it. his mother appreciates. Observations have been made not only of client behaviors during interaction with the horses. He loves the— he loves to be in the saddle. young adults…different than soccer because you’re dealing with another live creature and that gives you some sort of…a connection.effectively with animals.” John’s aunt readily promotes the CKRH program to other families with autistic children. “…just to see him having the bond with the horses…not necessarily a particular horse. “I would say that it’s good for kids. but also of equine reactions that seem specific to certain clients. 121 . as noted by Jan’s step-mother. And…just the relationship between the child and the animals…and I think that will carry over into…his relationship with kids and people in general…” Magic of the horse. but just a horse in general. During the second volunteer focus group.” Although Wayne does become attached to his mounts. And I tell them how he is now.

Denise feels strongly that a special connection can sometimes occur in either direction during the instructor focus group: Something in terms of the magic. every week. There’s a certain energy there. but it’s…(laughter from group) ooey-gooeys. her ears are always forward. and doesn’t want to move a lot…and her…way of telling you is her ear movement and her head movement and things like that. that. This has gone on.. the therapist and the instructor…have tracked this over a period of five or six weeks now. in terms of the energy – I often call it the energy…it’s a certain connection…I think…as a therapeutic environment as a whole…why does someone overcome these things to get to this horse that they don’t know. She has found this one little client. her movement is different. It’s repetitive.There is just something.Although acknowledging that some would view this as a syrupy overromanticized perception with no factual basis. her gait is different. over and over and over. and I’ve seen that with this particular horse. it’s the same horse’s attitude with the same leader…everything being the same except this one individual–[the horse’s] attitude is totally different. yes – document that! It’s the ooeygooeys of the world! But it’s real! 122 . when I can almost guarantee she wouldn’t have done it if it was a dog – we don’t know – but also. there’s a certain magic and a certain energy between certain people and certain horses…We have a hippotherapy client right now that…the same little horse who can be quite sour. years and years and years. and this is not just a oneweek thing.. there’s a certain something that – people think you’re crazy and people think it’s the ooey-gooeys of the world.

to make sure everything was O. and the horse had never spooked that way. there’s a connection that the horse and the rider have…that people don’t even have with each other… The instructors analyzed the human/equine bonding process as compared to interactions with other animals or pets. he frets…And these little wrinkles come up on his face…and if you’re leading him…he telegraphs everything to you. and theorize that a stronger relationship is forged when interactive training takes place: 123 . he gets this furrowed-brow look on his face. he’s just so concerned. A third similar example was provided by instructor Barb that involves a horse that reacted in an unusual manner when he sensed there was something wrong with his rider: …we had a…rider who had a seizure on a horse. something is happening with your rider. that she’d been having too many seizures. or maybe sitting too far back. and she had to have surgery. Your rider is overheating. Red stops…if Red even thinks that his rider is uncomfortable. you can see it–it’s written all over his face–he’s concerned. and the rider came off…they went to the hospital as a result of the fall.Instructor Mary gave an additional illustration of a therapy horse that seems especially in tune to his riders: Red is a perfect example…if his…rider is starting to go off balance. your rider…is sitting a little crooked. there’s something going on with your rider. And that would not have been discovered…I mean. If you look at him. your rider is starting to fatigue. and he’s got that look on his face. or whatever. ‘cause I guarantee you. you need to be coming to the middle and stopping.K.. and they discovered this had been going on. 100% of the time. and seeing what’s wrong with your rider.

often time you don’t do that. So. Six family members mentioned that the therapeutic riding sessions provided an opportunity for their children to learn and practice appropriate social behavior. into a dangerous situation! Barb: You’re not connected in the same way. But. whether or not they can fully appreciate the need for such actions.Margi: And I like that you compared it to dogs or cats. Alan: That’s right. you could do it with a dog. you might be. if you were teaching a dog to do something. you’re not. I don’t think that Meghan really recognizes yet that these people are helping her and she needs to say thank you or…I don’t think she has developed a relationship…I would like to think that it will happen…[but] I’m not so sure that that would ever change. and the student is to teach the animal that part of whatever they have to be doing. as Meghan’s grandmother clarifies: …I think that as far as being able to be socially appropriate with the volunteers. Practice appropriate social behavior. but you have to do it under a similar kind of setting. They only pet or play with them. because what about other animals? People like other animals. Alan: Well. why would a dog or cat not be the same? Except that you’re not riding them. Denise: No. in that sense. What I do think that it allows us to do is to put her in a 124 . Then they’d become the same thing. rather than teaching them something. Margi: Unless like they were doing agility or something. Now they’re a team.

being with your team.social situation where she gets to practice. that she still be put in these situations to practice that. but…in a new situation that has not been practiced. But at least she is understanding that this is when you say. but at the end of every lesson. Gratitude. “Thank you”… I think that’s an important piece that’s fitting with other pieces that maybe all of it combined is allowing her to become more socially appropriate. according to Wayne’s mother. though. which is simply…being able to greet 125 . is “to have to actually look at people and tell them his name and to ask them questions and to listen to the directions and…get that kind of effect…” Instructors and volunteers are aware of the need to provide this encouragement. well. we have our students thank their volunteers. not necessarily develop a relationship. and they usually go up and pet them. I don’t think that Meghan yet is ready to say ‘Thank you” and those kinds of things…But it’s critical. Doug’s mother discusses the support for appropriate social behaviors at CKRH that is not always possible in his public school environment: …one of my concerns…in that school environment is limited opportunities to… work on the skills that he needs to work on. even if she doesn’t really truly feel it…like we feel it. thank their horse. as Deb remarks during the instructor focus group: …it’s all part of the social interaction that we’re looking to provide…being with other students. One of the goals for the social time. but “This is how I behave”…and even though she may not truthfully get it…she is being put in a situation where she is experiencing that and…that’s what is the important piece for them because you have to be able to carry that through.

but…out here. whether it was horse or human… Deb: Oh. well then we just move on or whatever. Doug. but…we continue to move the bar relative to…what he’s capable of. behaviors at 19. Bob has achieved notoriety at the CKRH facility for his aggressive behavior aimed at both people and horses. And…because his peers…aren’t worried about stopping and slowing down and saying. through this structure. “Walk on. so…that’s been good. 20.” whatever. through this therapeutic 126 . And…they get that here…in other settings…well if he doesn’t say it. Behavior modification techniques were instituted by his instructors that have proven successful and resulted in more acceptable conduct in other social situations: Denise: And…one of the things I’m always noticing is that behaviors at four and five and even at 10 are one thing. yes.someone.” because they know he’s capable of saying “Walk on. it’s not cute anymore! So what’s happened in this lesson. just as an example…they don’t walk the horse on until he says. no matter what the scenario. then at four.” Now…a few years ago that wasn’t the case. first noted during his riding evaluation for acceptance into the program. but that’s different…if that’s what I view as appropriate in my brain. “Hi.”…and giving him a minute to be able to go. And again it just gives him a great opportunity in an understanding setting…to work on those things. “Hi. 25 and adulthood is totally different…If my appropriate social interaction to greet you is to walk up and hit you…which is what he did. really? With people as well? Denise: Yes. it may be cute – maybe not. when you it as hard as he does…but at 24. and he would still hit.

gosh! Denise: Yeah. everybody was fair game. Bob’s mother readily supports the group’s report: …in the beginning. his mother responds. to try for that to transfer – what is the appropriate interaction with other humans… Mary: …and his mother has said that has de-escalated…not to say that he doesn’t have outbursts from…anger or frustration…but…that is not his everyday normal way to greet people now. literally. When asked if Bob speaks to others in his class. Margi: Really appreciate that! Denise: Yeah – the first day he greeted me.riding lesson. And even children. there are still opportunities to practice proper conduct. and I’m sure the children in his daycare are thrilled. and to interact with people. it was me and [Executive Director] Pat out there. through his aggression. Deb: Oh my gosh. you better duck. If his hands were flying. so it was me and Pat sidewalking. I got a bloody nose – literally!!! Deb: Are you serious??? Oh. Now he’ll come in having a bad day and we try to warn them if we realize that the day is kind of rough so that they…put on their suit of armor…but there aren’t that many of those anymore. If his feet were flying. because we wouldn’t put a volunteer in the lesson. “You 127 . Despite the history of physical assaults. unfortunately. it used to be he hit poor Socie…I lost track…I think initially…part of it was the fear of just the heights and what to expect and what to do…but that’s how he deals with them. you better duck…and he does better with them. You know. is we’ve changed what is the appropriate interaction with Socie.

there is interaction at the CKRH program between both clients and people and clients and horses. He will tell them goodbye when he leaves…we’ve made it a point. and that speaks to the horse. Does that make sense? Deb: And that’s our goal! 128 . and still they’re improving and still they’re…moving up. because it’s the fact that we’ve got the activity with the horse that has brought us up to the human interaction. I don’t know. a lack of sharing. is one of the side effects of the diagnosis. and I was sitting here thinking it. Denise: Well. because. Is one type of relationship more effective. so just the fact that we’re talking about that individuals connected with Mary or connected with Alan. But he at least tells everybody goodbye.” Horses or humans? Clearly. if they’re around. remember…in the description of that diagnosis – a lack of social skills. a lack of emotion. we’re talking about the human interaction. or maybe John asked it – about how “Is it the horse or is it just…[the instructors]” Margi: …he said it. or with Barb…and then have moved on…The fact that we’re talking about the human relationships. Deb:…I guess the way I feel is…yes…the way the way the instructors bond with the students or interact with the students is very important. to me is…a huge success. a lack of appropriate human interaction.know. or are both necessary for the success of this intervention? Deb: …did you ask it. and excelling. but I think it’s proof that these students have gone to several of the different instructors.

self-identity is strengthened. Since there are no postulated theories to explain the abnormalities in the development of children with autism spectrum disorders. Erikson’s theory of the development of self and ego is tied to chronological periods of the lifespan (Edelman & Mandle. The psychological benefits presented during data collection may all be considered constructs of personality development. as the goal of healthy emotional development is to become an adaptive. this introduction will not discuss Erikson’s conventional developmental stages in detail. 2009). Although there are many human growth and development theorists. There are no guidelines specific to optimum psychological growth children for affected by ASD. As each critical step is mastered within the appropriate stage. He presents specific constructs that require a resolution of conflict to be resolved within the following approximate chronological periods in the growing child: infant/toddler (birth to two years).Psychological benefits. particularly self-concept. Many of his general constructs. and adolescence (puberty to adulthood). early childhood (two to six years). the work of Erik Erikson has been selected as best reflective of the variables produced by this data (Erikson. are appropriate to more than one age 129 . middle childhood (six to eleven years). but will utilize many of his constructs to organize the data from this specific population. along with a personal sense of worth. but it is assumed that achievement of stated developmental objectives for general populations should also be considered advantageous for this population. 2002). His psychosocial theory describes the basic need for an individual to develop a sense of trust in himself and in others. effective social being (Murray et al. 1950).

Another hallmark of the infant/toddler stage involves the establishment of personal autonomy. Following the foundation of trust in caregivers during the first two years. selfcare activities.group as the individual matures and the tasks to complete within that general category are expanded or further developed. the well-adjusted toddler begins to develop confidence. The significance of self-concept increases throughout adolescence. For example. Psychological variables are also affected by physical. and a sense of security. the tenets of successful self-image will be greatly expanded to include achievement. locus of control. and a sense of worth. it is unfortunately a classic deficiency of ASD. self-esteem. The challenge of self-control begins in the infant/toddler stage and continues through early childhood. While development of empathy is also vital to the foundation of social competence from this stage through early childhood. the ability to deal with 130 . or self-concept. During early childhood. when it contributes strongly to the emergence of identity formation. cognitive. the acquisition of patience. self-concept now includes the accrual of personal values. although trust is one of Erikson’s key concepts for the infant and toddler stage. pride. and may therefore be categorized for the purposes of discussion in another part of this chapter. independence. In middle childhood. body concept and gender role. and is also discussed in the area pertaining to social benefits. data relevant to this topic are described in the social benefits section. reduction of inappropriate behaviors. Concepts within this category include control of emotions. and social factors. as do participation in character-building activities and finding direction in life.

and self-efficacy. task mastery. The broad concept of industry emerges during middle childhood. Although it is typically difficult for a child with ASD to express the reasons for his or her behaviors. and activities (American Psychiatric Association. The trademark failure to relate appropriately to others places children with ASD at a disadvantage for healthy emotional development. rigid. 2003). There is also a focus during this stage on the emergence of moral development. Data related to toilet training are presented under physical benefits in this chapter. Children with ASD can present with a wide range of abnormal behaviors. and aberrant postures or facial expressions such as grimacing. unusual attachment to inanimate objects. particularly in the middle childhood years when social support is crucial (Berk. Impulsivity. excessive fearfulness of harmless objects. especially when alone (Sadock & Sadock. These children are classically resistant to change. and toilet training. often responding with aggression or temper tantrums. There is a characteristic lack of interest in participatory or interactive play or a willingness to share enjoyment of activities with other people. older adolescents and young adults may be 131 . 2000). including compulsive or ritualistic actions.transitions. complete absence of emotional reaction and selfinjurious patterns of behavior can also be representative of this condition. and includes the goals of challenge. 2004). but they may also display sudden unprovoked mood changes. which incorporates the constructs of responsibility and trustworthiness. monotonous patterns of movement. interests. An abnormally obsessive preoccupation with one or more areas of interest may provide an exception to a generally restrictive pattern of behavior.

disillusionment. Children who develop feelings of inferiority or inadequacy may prove unable to learn or complete projects and may experience difficulty working cooperatively with others. and others.. and remains a critical component that continues to develop through a variety of relationships and experiences as the individual matures through early and middle childhood to adolescence (Edelman & Mandle. but emotional and behavioral factors related to ASD may appear–or linger– throughout many age ranges. but can also appreciate and accept the factors that make others seem different from themselves (Murray et al. the acquisition of skills. independence. 2009).. Self-concept. 2009). and alienation as the child moves through adolescence (Murray et al.. The data in this section are organized relative to the broad developmental constructs in the order that Erikson’s theoretical concepts first appear in the chronological stages. peers. especially if they have the cognitive skills to recognize the impairment that so effectively separates them from peers. and is affected by relationships with family. Negative or low self-concept may lead to academic or adjustment problems for the school-age child. and ideals. 2002). The quest for a healthy self-concept begins in the infant and toddler stage of development with the appearance of confidence. 2009). 132 . They have a strong sense of self as they relate to others.predisposed to depression. Self-concept may be defined as the way an individual sees himself (Murray et al. Individuals with a positive self-image like and accept themselves for their physical characteristics and their abilities. and feelings of insecurity. and self-control in daily living activities. values. and security (Berk. 2004). success in activities or play.

’” Meghan’s grandmother expresses the need for children with ASD to receive this benefit. that self confidence.” Robin’s mother describes her observation: …his confidence has just been huge since we’ve come here because he has actually known something…especially because he’s such a little guy…he’s only three and a half feet tall and he just hops right up on those huge horses. “…he just feels so confident. so he’s got one up on everybody. Parents or caregivers of 11 of the children linked therapeutic riding with increased levels of confidence.” Wayne’s mother notes. “I think more self confidence. “Yes…it’s an amazing…thing…I’m sure he has more self confidence since he does it…He thinks he’s bigger than the world. I guess. so he rides a horse and no one else he knows rides one.Confidence. Yeah.he seems more confident and he knows what he’s doing and he feels good about it…he seems so much happier than he ever was. When asked by the researcher about any noted changes in her son’s self-concept.. and has been so…good for him is that…it’s…given him confidence and it’s given him a sense of 133 . Jim’s mother mentions. Jerry’s mother illustrates a comparable reaction from her son. “…I think it’s her confidence. I mean she’s out there by herself…And she really sets a horse pretty I think…She feels confident…And they need something for their confidence…so we’re very pleased.” Brian’s mother links accomplishment with improved selfconfidence: that’s why this program has been…so gratifying for me. and ‘This is something I can do and this is something I really enjoy doing. maybe…to some extent…yeah.. and he’s not afraid and he’s excited to do it and he’s good at it.

it’s amazing…when I turned and I latched the gate and turned and she was taking that mini off down the track. “…it’s kind of a combination of accomplishment and confidence…During the instructor focus group session. Mary supports this statement with an example of Jan’s increased self-assurance: And I think her confidence has grown in leaps and bounds.accomplishment…in being…in the riding program itself. “I know!” Volunteer Shirley has observed the difference between less experienced clients and those who have developed the confidence in their ability to ride independently.. You know [you ask them]. And her mom…she’s like. When asked to name the most positive benefit his daughter had received thus far. took off with her!!” And I was like. she just. and…the biggest example of that is the Special Olympics and…he has done that twice and it’s just been…I think some of the highlights of his life.” Kerry’s mother regularly recommends the program to parents of children with ASD. Dave’s mother 134 . “Do you want to be off lead?” “Yes. I turned to her mom and was like [facial expression of amazement]. And…it’s just given him…great confidence.. Jan’s father spontaneously describes confidence. without a horse leader: …it’s fun to see the little ones and I think you could really see the change there. like.and that they have the confidence to do it. “I just tell people…go out there and first of all it gives them a confidence.” After both parents agreed that the program improves their sons’ confidence. “I couldn’t believe it. but when you see the independent riders…it makes you pretty proud that they can do it.

It’s a great program and to see that is just wonderful. and excel at it…’” Rick’s father expresses the same belief: I think the biggest thing that he takes away from this is that…he has the confidence that he can basically do anything that he really puts his mind to. and his mother confirmed that.” and…I thought about that and…I think if he is challenged in Alan’s class and gets the confidence…and rises to the occasion of the other students in his class…that will give him confidence into going into the school year. regardless of disability. I say. Rick’s father. And 135 . “And I bring that up to him. and I know that you’re going to be able to handle this too. who works as a volunteer with the therapeutic riding classes. “We’re going to put him in school all day.generalizes her opinion to include all clients. other clients ride over the years and…you take a very timid little child and put them up on a 2000 pound animal and then some don’t like it at all…but I’ve seen others that… just love it and…you can see the joy in their face and the confidence that they…are on this huge animal and they’re mastering skills and they’re doing things with these animals. ‘Look – look what you’ve done! Gosh. The optimum outcome is that confidence developed through therapeutic riding activities can be transferred to other areas of a client’s life. has also witnessed the emergence of confidence in many children: And…I’ve seen other children. you’re in the highest riding class there. for the very first time. and look how much you’ve accomplished. One such example is described by Mary when discussing Steve during the instructor focus group: …his mom had said. and…she said. he just started. every day.

it’s…a respect.) Alan: No. they’re lookin’. that’s all it takes! And they’re out there.it’s…a respect. Alan: But why? Mary: So they can be in Alan’s class! (Group laughter. “When do we get to ride off lead? Jenny. I won’t say no fear. Independence. without sidewalkers and a volunteer leading their horse during their lessons: Mary: [In] my two Horsemasters classes. they’re pullin’. and then of course they wanna trot – they wanna trot…And…I’ll say. Three parents spoke to gains in independence and instructors made note of their students’ common desire to ride independently. no! Mary: So they can be independent! So they can be independent. all I hear is. when you can steer your horse. They’re like. or off lead. and… Barb: I think that’s the big one. can we ride off lead today? Are we gonna ride off lead today?”…They wanna ride off-lead. don’t you? 136 . and you can stop your horse…”…And boy.…they’re turnin’ and…That’s the motivation…to be offlead. “Well. but I’d say that he has a healthy respect for things and…he won’t do anything foolish. but…he’s more likely to try…certain things than even…what I would consider more mainstream kids…They’re amazed that Rick will even get up on a horse. and a willingness to be able to try other things. “I don’t want to be around the horse”…and so from that standpoint…it’s confidence.

Mary: Yeah…so they can be independent. which was three or four weeks ago…he did not want his father out there with him in the ring.I have…a little girl who is non-verbal.” Mary: ‘Cause the…the session before. what do I do? She’s pushing my hand away!” And I’ll say… [shrugs as if to say. was always the one to sidewalk for him. and she’ll take that hand…. but it’s MY team – my dad is out there. “Mary. the program needed his father to sidewalk with him. They wanna be independent. this was a graduation. For him. [demonstrates removing the sidewalker’s hand] (Much group laughter) Margi: You don’t have to be verbal to get that point across! Mary: “I don’t want your hand on me. his father. I can do [it myself]…” And the sidewalker will say. no” [said Rick] 137 . we said. this was a moving up Barb: Independence. I still have a team. “Well…his dad will be here…should we let him in as the sidewalker?” “No. he was not little even then! Denise: …the last lesson that I taught him. and we do an over-the-thigh hold with her. that’s real independence Denise: “I am out here on my own. and his sidewalker.. who volunteers as a sidewalker with his son’s class: Barb: Another measurable…is…that…for years. because he did bail [jump off the horse] (group laughter). And he’s not little.. He didn’t want his father beside the horse. “Whatever!”] The instructor group also discussed Rick’s assertion of independence from his father.

” Meghan’s mother also appreciates the beneficial effect of the Special Olympics on her daughter: 138 . And she’s so proud.” and she recognizes a specific advantage to this activity for her son. you know. So he can do it and be proud of it. the Night of the Stars…he did that for the first time this past year. “…when we get home…he’ll have his riding helmet in his hand and he will tell every neighbor that is outside…that he was riding his horse. It gives them something to be proud of. “Here…he’s got the sidewalkers.” Jerry’s mother feels his success in a rather unique activity allows for this emotion. but he’s getting that feeling of independence and…he’s getting the full total…input from that horse. Steve’s mother remarks. Brian was selected to ride a costumed auction horse in CKRH’s annual fundraiser this past summer.Brian’s mother compares her son’s riding experience to his participation in baseball.” As his mother explains. “…he…participated in the big annual promotion that they have…the gala. “. When asked why she would recommend this program to other parents of children with ASD.. Pride (Berk. and thoroughly enjoyed that. whereas…the baseball…it’s just more of a social interaction…” Pride. 2004) is cultivated through external recognition and positive feedback. “…it makes them proud. “…he’s not competing against anybody else because he doesn’t like competition.. So he loves it and he thinks he’s big stuff.when she can go out to Special Olympics and she can ride that horse and so the family’s coming from everywhere. Family members of seven of the children noted a sense of pride that resulted from accomplishments in therapeutic riding activities. and just gives him a great sense of pride…” Meghan’s participation in the Special Olympics caused her grandmother to remark.

I’m seeing that. And she did something remarkable one day and we were walking out of here. 139 . Of course she won the silver two years before.” And she looked out at me out of the corner of her eyes with like a little smirk! Oh…it was like she felt that—it was the kind of look you get from a kid that feels like. “Jan.” I’d never known her capable of that emotion and I saw it in her face… And that’s the first thing that comes to my mind…For me it’s the pride thing. I’ve never seen it. very proud. it’s a good fit and it makes her feel proud. very. But this week she said. She then adds a specific expression of Meghan’s sense of pride: When they had them bring a memory object to a school activity this week…I would always expect her to say she wants to take Godzilla or a dinosaur because that’s what she always takes. particularly when she asked to take the medal to school. but she did get the bronze and we were very excited. For her to have pride in herself. When asked to describe any changes she feels have resulted from participation in the therapeutic riding program. “I want to take my medal. That’s huge. and this year she moved up to a little bit older class and more expectations. “I deserve that. And really and truthfully I think she seems to truly feel a sense of pride and satisfaction in that. and I was like. I am so proud of you. I’m proud of myself too.Oh she’s very. Jan’s step-mother states: I honestly think she’s proud of herself…I have never seen the expression of pride on Jan’s face.”…here [at therapeutic riding]…and in those things that she’s doing.

And she knows that she’s doing something new and different and challenging…And she’s able to do it… After watching his daughter sit astride a horse for the first time. She has been so sheltered and unable to do so many things that it’s like…her chance at soccer or her chance at…some kind of sport. “And their successes that come. Building a sense of capability and competency supports positive self-concept. they own those.” Jan’s instructor. “The biggest benefit is that he’s able to do this and…be proud of himself and…succeed at things. took note of the limited opportunities their children typically have. well that started with…we didn’t know if she’d ever even put the helmet on. “…and then this…victory today of actually getting on a live animal. fully appreciates her pupil’s progress with the 140 . When asked which one thing was the most positive benefit his daughter. Therapeutic riding provides an avenue for many of the children to experience success. and they should. Jan’s father tries to describe the full scope of her progress. “…achievements and how you arrive at…meeting a goal is something that has not come easily for him.” Instructor Mary has witnessed the change in attitude success brings to her students. such as Brian’s mother.” Dave’s father reports his son was able to earn a merit badge in horsemanship in Boy Scouts. I think Jan is getting a sense of accomplishment from this. including Steve’s mother. Mary. which is noted by eleven family members. too…they take full ownership of those.” Jan’s step-mother further illustrates this viewpoint: Honestly.Achievement. Jan. “…I’m just trying to think of the right word…it’s kind of a combination of accomplishment and confidence… Several parents. her father replies. had gotten from the program. too.

” Meghan’s grandmother expresses her sentiments regarding the opportunity to achieve: …there’s not many 10 year olds that can get on a 16 hand horse and off by themself and do what she’s doing…And how much is she going to be able to accomplish in life? And she’s able to do this…These are the high points in her life.” Her step-mother has also observed the striking improvement in Jan’s level of accomplishment. “When we started. Kerry has been encouraged to take part in sporting activities even if he feels limited in his capabilities: …I think it’s like a. because she’s not going to have no academic achievements. she wouldn’t even touch her. She couldn’t even be within 10 feet of her.miniature horse. Kerry. we don’t think you have to go out and be a…guy that plays every game…but…there might be a few games that you could play really well…You just might not be the Mr. she leads the miniature. He’s afraid to because he’s a perfectionist. 141 . definitely a boost to his ego…because there’s so many things he can’t do…I have him in gymnastics because he’s…never really played any sports. by herself. And now she holds the rope and walks her independently. she takes the miniature around the barrel. Mary asks her to do. “You know. She’s not going to go to college…she might get a degree from school but it won’t be—this is her thing and she loves it. She’s not going to have any…athletic achievements. because they’re like. According to his mother. He wants to get it right the first time and he knows he’s not good at a lot of things…and his therapists are really good about this too. if that’s what Ms. “…for her to conquer the miniatures…she’s telling the miniature [horse] what to do now…she lets the miniature graze.

Athletic, but there might be something like horseback riding that you’re really good at.” He’s really good at that, you know. Although Robin eagerly competes in sporting activities at his school, his efforts often produce very disappointing results. His mother expresses her delight at his success in therapeutic riding: I sometimes tell this story about how he used to say, “Mommy, I’m such a loser,” because at school…no matter how hard he tried to win a race or…play basketball – any kind of athletic…competition at school, he always lost…and I thought how horrible for a child that, no matter how hard they try, they always come in last. And here…he’s good at it. So I get all emotional, I’m sorry. Self-esteem or sense of worth. The construct of self-esteem may be defined as the self-evaluation of personal value or worth (Berk, 2004), and can be reflective of physical, academic, and social competencies. It is one of the most significant aspects of development as it strongly affects the degree of psychological adjustment, which in turn influences future patterns of behavior. Children with ASD may be particularly hindered from developing a sense of social worth due to the limitations characteristic of this condition. Six of the family members credited the therapeutic riding program with improvements in their children’s self-esteem or sense of worth. When asked to choose one or two of the main benefits Meghan has gotten out of therapeutic riding, her grandmother responds, “How would you describe giving her… [a] sense of worth?...Because look at her out there...they have to know that they’re doing something that everybody’s proud of. They have to know.” Kerry’s mother states, “I think this has definitely been a boost to his ego, for sure.

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Definitely.” While discussing the main benefits of the therapeutic riding program, Jan’s step-mother remarks, “Well let me put it this way. There has been nothing else I have ever seen that has made her feel as good about herself, I don’t think.” Steve’s mother recalls her excited son’s reaction to being told he had been selected to participate in the Special Olympics riding competition, “‘Mom…somebody thinks I can actually do something right.’ And I’m like, ‘Well yeah, Steve’…He said, ‘I guess maybe I am…good at something,’ and I’m like, ‘Yeah, you are good at something’….his self esteem is not very good.” During the instructor focus group, Denise suggests that CKRH provides an accessible environment that can help foster these qualities: …the benefits come from the self-esteem; the self-confidence that is derived from being able to do with the horse what they’re not necessarily ever given the opportunity. It’s not that they can’t do it other places, it’s that they’re not necessarily given the opportunity, I think, to do it other places. Locus of control and empowerment. Individuals with an internal locus of control believe they are responsible for their own accomplishments and tend to experience higher levels of achievement (Edelman & Mandle, 2002) than those who feel they are at the mercy of external factors beyond their control. Gaining control over the actions of the horse may contribute to the child’s sense of personal command, as emphasized by class instructors and volunteers and reported by seven family members, including Kerry’s mother, “Because…they’re on this big horse and they’re somewhat in control, which half the time they don’t feel like they’re in control of their own bodies. They’re in control of this horse,” and Bob’s mother, “He tells Socie which direction to go and so I guess they’ve worked some on how to operate

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the reins and getting the horse to follow…so he can be in control…” During the instructor focus group, Denise comments on her eventual success in handling her instructional horse leading to a lessening fear of other animals for Jan: And…this is a 19 year-old young lady who has never overcome a fear of other animals. They’ve [the family] tried different things; they wanted to have a pet in the home…and she’s never overcome the fear of dogs, cats, and other animals. And now, after…seven, eight, nine, ten, this is ten weeks in. She’s taking ownership of this miniature horse. Why is this horse different than the dogs they’ve tried for the past 15 years? Annie’s step-mother elaborates on this story: …I would say that it’s good for kids, young adults…different than soccer because you’re dealing with another live creature and that gives you some sort of…a connection and a…kind of a hierarchy in the animal kingdom…you are a homosapien…you’re over this creature and you can have dominion or whatever the word is…And so that’s really good for her...since she’s been…friends with our cat, Munchkin…he was sitting in a chair one day and she wanted him to move and I said, “Well, give him a little nudge, out of the chair…just put your hand on him”…so I took her hand and showed her how to do it. Well…for several visits after that, she wanted to know if it would be alright to nudge Munchkin off the chair, off the ottoman. She liked being able…[to] have charge of what’s going on. So I think that’s huge. And somebody in her world, to be able to have that some way.

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Class volunteers such as Shirley readily note in their focus group the potential value gained from developing effective riding skills, “Well, any time you can get a kid up on a horse and let him think he’s in control of a situation, where a lot of times he’s just completely out of control…it gives him a lot of support.” Later in the group discussion, Sherry remarks, “I think something Shirley said earlier, though, the sense of being in control. Some of them have the only time in their whole day when they had something that they’re telling [what to do]…” In the second volunteer focus group, Perry expresses the same viewpoint and further links locus of control with self-esteem, “I mean…they’re sitting in a world up above the world now…looking down at everybody else, and they feel like maybe they have some control over their lives that they don’t have in their normal day to day existence, so I really think it gives them self esteem…” When asked why he thought therapeutic riding was one of the children’s favorite interventions, volunteer Perry credits the presence of the animals, “I think the horses. I mean, and there again…it gives them control. Possibly some of their other therapies don’t.” Horseback riding instructors for all populations commonly stress the need to assume a commanding presence over the animal in order to control it safely and successfully, as discussed in the instructor focus group: Mary: And they know that;…they’re in control…when my guys are up there, I’ll say, “Who’s in charge?” But…you can tell it’s been a long time since someone said that to them. And they’re like “Oh, gosh, I…I..I am!” [And I respond] “That’s right! You are – you’re in charge!” And…once they realize that, they much more take ownership of their horse, and their team, and their task. Margi: Can you explain “the team”?

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Mary: The team. Their leader, and their sidewalkers. All the volunteers, and I emphasize that with them…“This is your team, this is your team…you’re the boss.” And I’ll say, “Who’s the boss?” And you can tell, the look on their face, and they’re thinking, “Does she want me to say she’s the boss??”…And then, all of the sudden, it’s like, “Well, gosh, I’m the one driving this bus here. I’m the one who…can make it happen.” While the term empowerment is not commonly included as a milestone in child development, it is often used to describe a process that equips or supplies the individual with an ability to gain a sense of control over his or her life; therefore, it is logical to link this concept with that of development of an internal locus of control. Mary illustrates in detail how rare it is for a child with ASD to exert much direct control over the aspects of their daily lives: Oh, yeah, yeah…we’ve all said this – that…the horse is very empowering. When you put yourself in the shoes of that individual, especially children, they’d had stuff done to them all their lives. They’ve been poked, and they’ve been prodded, and they’ve had all these decisions made for them. “Well, he’s gonna take this medicine, and he’s gonna go [here]…he’s gonna do this, and he’s gonna take…speech therapy; and he’s gotta go to the orthopedic thing, and you’re gonna be in this class, and you will wear this”…and they have all these decisions made about ‘em, and a lot of ‘em are life-directing decisions, and they have no control over that. And you put ‘em on a 1200-pound animal and go, “O.K., you’re the boss…you’re the boss.” Hugely empowering…

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Executive Director Pat describes the initial ineffective attempts of a child to successfully lead a miniature horse, which often results in loose horses being recaptured by staff and volunteers until the child learns to develop the attitude and proper technique to control the animal: And so sometimes…they are oblivious to the fact that they have just turned a horse loose. Just sort of wondering around…not tuned in. But then over time…you’ll look out there and you’ll see…the same children…walking with the horse, and they’re clearly in control of their horse…it’s a skill that they’ve learned. They’ve learned to control themselves a little bit. They’ve learned how to use their control to affect that horse…or what they can do to…really improve the dynamics of having some sense of control not only of themselves, but of their horse. I think that’s a really good feeling for children…“Ok, I now know how to do this. So once I’ve got this, if I can access what I know about this again…I might be leading this horse and I might be able to make it stop and go and…hang on to it…” So I think it gives a real sense of empowerment…to children, and makes a focus outside of themselves. Jan’s step-mother links another related concept previously discussed in this section, “So I think Jan has a sense of empowerment…and that gives you confidence.” Gary’s mother observes the transference of such traits honed in therapeutic riding to other novel situations, “…he normally wouldn’t like things that are outside of his routine or what he’s accustomed to, but being able to do the riding I think, it interests him enough to try something different outside of his comfort zone.” Rick’s father also remarks on his son’s willingness to try new things in other places, and his mother agrees, “Yeah, and

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they don’t want to brush their hair.” Self-care skills in daily activities. they don’t want to brush their teeth…if you get them into the grooming of the horse and the brushing of that and they feel some motivation to clean and to brush…we’ve had parents say that they’re brushing their teeth and combing their hair at home. The willingness to assume self-care in activities of daily living. They don’t want to clean themselves.now…he’s able to play at Kids Place and do all that climbing and stuff. it’s about a skill that you can take with you…and for somebody that…learns to focus on buckling a helmet…they can buckle their seat belt…and if they can learn to pick up a brush and brush the horse…autistic children have. and it used to be that he just stayed in the ball pit because he couldn’t do anything else. Because the parents can then say [to the children]…“just like you do to…the horse at CKRH…go do that. contributes to positive self-concept and is an important aspect of normal toddler and early childhood development. such as personal grooming and dressing oneself. but it is often disregarded by children with ASD. a real thing against personal care. Executive Director Pat discusses the value of skills the child is motivated to perform during therapeutic riding lessons that can often be transferred to daily life: …for a lot of the riders. a lot of times.” It’s the motivation and the idea of…devoting some time to the care of something…kind of transfer to devoting time to their care. I think. 148 . And those [are the] kinds of life skills that you see. the autistic population as well.

And he had never done that before…And just that motivation of. And they just expected him to do it. I want to be involved with 149 . “I want to participate in tack and groom. Where…with OT we’re trying to teach him how to buckle and he was not motivated to do it at all. Do your task and then complete it.Instructor Mary recounts one parent of a client with ASD describing the utilization of this approach in asking her daughter to put away the pieces of a game she had been working on: [The mother] says…“I can equate that [the lesson]…and I can say… “You do your horse activity.”…It’s life skills…Complete it. I want to help my horse. While speaking to the strong motivational factor present. they usually are just not interested. and putting the game away is all part of it…just like when you put away your saddle and your tack and stuff. not motivated to participate in selfcare… Well…they allowed him to participate in tacking and grooming. Robin’s mother readily recognizes the contribution to self-care skills as one of the most beneficial aspects of the therapeutic riding program: And then the most amazing thing was that he—I get all emotional when I talk about this because having an OT background and getting him an OT since he was an infant…of course we’ve been working on all these self-care skills because with autism. And the next thing I know. So he starts learning to buckle and unbuckle because he really wanted to help with the saddling of his horse and hanging up the saddle. he’s buckling his own buckle. So I started noticing that…he was having to buckle and unbuckle that saddle. and this is all part of the horse activity…you do this game.

brushing his own hair…He had never done that before. impulsive reactions to stimuli in the environment (Berk. was motivated to do it here. enjoyed doing it here. temper tantrums.” And so after I saw that I thought. And I thought “I cannot believe it. So I’m like.” And he started brushing his teeth and he started wanting to participate in bathing. he’s doing it independently. “Oh my gosh. sudden mood changes. I just couldn’t believe it. he’s at home all day looking in the mirror. 2004). and helps to prepare the child for the acquisition of pro-social behaviors (Murray et al. And I started seeing him do all these selfcare things. emotional control is often a challenge at any age. we saw this carryover. Well the next thing I know. and a wide variety of inappropriate behaviors. “I know…why he’s doing this. everybody needs to get into this. So he was brushing the horse and helping with bathing. And he just one day just started doing himself. That…it came natural because he learned it here. I thought. For the average child with ASD who may readily exhibit hypersensitivity to sensory stimuli.”…because…this was the most powerful motivator he had in his life. 150 . 2009). And then the next thing I know. Emotional self-control involves the ability to regulate emotions and inappropriate. I didn’t even ask him to brush his hair.” And he was proud of it. And all of a sudden. to get him to participate in self-care. and there he was doing it.” All these years of OT…it was constantly helping with grooming and self care. and he was not interested. Such self-regulation typically begins to appear after 18 months of age and continues to develop into early childhood. “Oh my gosh.my horse. Emotional self-regulation.

but they must learn to effectively cope with them. she didn’t want to walk through the door of the barn. “From the beginning…he was scared of horses.” For Meghan. for like the evaluation with Denise. Irrational fears are not uncommon in young children. Instructors commonly utilize miniature horses in a gradual desensitization approach to help bridge the gap to a larger riding animal for those clients who are fearful. “…getting on and off. This is great’…then he wasn’t scared of horses at all anymore. Not while she’s on.” Jan’s initial fears are mentioned by her father. When asked if her son Kerry had always enjoyed riding the horses. as her mother explains when asked if she had initially been afraid to ride. I like this. according to the perceived level of threat to their safety. 2004). especially if this fear is preventing them from accomplishing desirable goals. ‘Oh. but that was the interesting part…once he got up and figured out. no no. toddlers and younger children learn to judge through repetitive experience whether to approach or retreat in a number of situations (Berk. “…when we first came.” The enjoyment that comes from riding can be a powerful counterbalance to any present fears. But that movement from sitting there to the ground just was a big fright…it was very frightening 151 . “…I know we’ve had students out here that they just started fooling with…the minis [miniature horses].Control of emotion and overcoming fear. as described by volunteer Shirley during the first volunteer focus group. Let them look at the minis and…worked their way up…just get them used to the little ones and then coax them on up. mounting and dismounting provided the most fearful challenge. Family members of four of the children in this study reported some level of fear that they had to overcome in order to participate in therapeutic riding. his mother responds. With the assistance and reinforcement of caregivers.

And. And I get to leave my little three and a half foot tall boy that does this. Robin’s mother admires her son’s willingness to ride: And just to…be brave enough to do it. he wouldn’t touch any animal…He would rather look at a tree than an animal. so it’s been a wonderful thing…It has been so good for him.” Because I thought... “I don’t know if I could get up there and do it. “Well maybe I should try to be a sidewalker. and not only just here. John’s aunt describes a dramatic turnaround in how he relates to animals in general since his gradual introduction to the CKRH horses: And so two or three years ago. and most kids want to look at the animal. in all areas of his life…We have…seen such a big difference in…how he relates to animals…since he’s been riding Socie. he was fine. But….And when he met Socie.” but I don’t think I could because I would be afraid. I feel so intimidated and I think. he was a little intimidated by the size…and he would kind of scream…a little bit when they started to put him on because he was intimidated…But once they got him on Socie and started riding.now they’ve got to the point where he’ll walk up the mounting block himself and he’ll stand there calmly and he actually raises his leg to get on Socie. now he actually looks at cats and dogs and…other horses. because…sometimes when I’m standing next to the horse. He went up to the fence just today and started looking at this horse that he had never been up close to.at first. before we started.” As a parent who harbors some fear for the horses. And he was very very close to it…that’s a big…difference from how he first started out…so we were really pleased with that…And so now when he looks at that cat 152 .

Jerry’s mother provides a testament to the soothing effect of the riding lessons: …I’d say that he definitely follows more direction now. He.” Jerry’s mother observes positive changes in her son and offers an explanation. thrown a fit or had a meltdown or anything…which is very common…I’ve never seen him have anything like that… The only thing I think that my husband and I can actually pinpoint is Ethan’s behavior…is a lot calmer in general…and when a session is not in. rar. “He keeps it together here. he even ran over and touched the tail of a cat.’” Kerry’s mother states simply. ‘Rar. he becomes 153 . Jerry has become a much calmer person. “It’s like she holds it together until she gets off the horse and she gets with us and it’s like. rar. He was more aggressive…and I almost think it might be more the size of the horse that has knocked him down a level.or dog and he even laughs at them sometimes. but it is a commonly held belief that contact with the horse in the therapeutic setting is responsible for a reduction in such behaviors. like. The colloquial term meltdown is frequently used to describe the negative behaviors often displayed by children with ASD. It’s from his involvement with an animal.” When asked how her son responds to his instructors. I mean when I see that I know it’s from Socie. Eight family members and several staff members and instructors note the children’s apparent ability to exert more control over negative behaviors during therapeutic riding lessons. rar. “…behaviorally. has never been disrespectful or not. as far as I’ve ever seen. Less inappropriate behavior. Meghan’s mother describes her daughter’s inappropriate behaviors and outbursts often displayed during other types of therapy sessions but absent during her riding classes.

temporarily. he doesn’t want to get off and quit. and we actually had to dismount. as a 154 . who used to throw himself off the horse! I mean. When asked for specific examples of changes or improvements in their clients. and he was doing a lot of bouncing on the horse. the instructor focus group provides input on Rick: Barb: …with some it’s self-control…like Rick. Denise provides more details on a potential cause of Rick’s frustrations and the unified team approach that was employed to help satisfy his need for a routine while maintaining his mounted position including. and he is calmer during…[the eight week sessions]…We’ll take all the calm we can get…not that it lasts for the entire week…I mean we still do…therapeutic massage and stuff like that. Hormones are kicking in. the use of his father as his sidewalker: It was the fall of 2007…Rick…[was] going through puberty. if you stopped for a nanosecond. amazing. you had to physically hold him on! (Group laughter) Because he was getting off… Deb: Wow. He wants to know. which. but we won’t have to do anything today… or probably this weekend because he’s just got his fill. very sweet child. “What else can we do?” Later in the discussion. but he is so aggressive that he is a liability. Alan: Gone! Mary: And now. and not purposefully would ever hurt anybody. and…for the past six months or so they had had a lot of aggression issues… He doesn’t know how to process and handle…a lot of this.very aggressive…He’s a very loving.

” he can get on the mounting block and stand without doing any of these behaviors. Barb: We couldn’t keep him on! (Group laughter) He’d just decide to get off.. Denise: See. there’s some improvements over time… During the first volunteer focus group. these types of…behavioral issues…he can now come to a lesson. he would pop up and down in the saddle. and when I tell him. and he’d just decide to get off. he was screaming so…his mother just took me over to the side after class one day and said. and he has just improved dramatically…he’s a student that…speaks repetitively to himself. we’re gonna write it down. We’d be on a trail ride or something.”Tell him ‘Nice voice or no screaming. Shirley describes the use of the horse as a motivator to modify Doug’s inappropriate behaviors: Shirley: …when Doug first started riding. Deb: Oh. I got a lot of aggression…there again. he needs to jump up and down…flapping. we’re going to ride.result. he was not able to–and that’s when we stepped back and we said. He no longer does that. we’re gonna follow a structure.’” and it got to the point he went a couple sessions he wouldn’t quit 155 . “O. “O. and…he progressed extremely [well]–that’s when he started learning to steer… Instructor Deb worked with Rick in a later riding session and can appreciate his improvement over time: Deb: We have a student. and Barb says she’s worked with him as well..K. that’s amazing. get on his horse…when I first started teaching him. that amount of change at that point.K. We’re gonna document a plan..

In the instructor focus group. stands out for staff members. volunteers. “One. and then count. structured approach to handling Doug’s outbursts during a class: Denise: …Doug had a behavioral plan and it was for volunteers—one. knowing that this child had a history…I was out with [Denise]…as another staff person being present at his 156 . It’s not dismount and go home. come back. Executive Director Pat describes the first day of his client evaluation: …I will tell you when we did that evaluation that day. “Doug. I never had to dismount him. this is what mom was using…It was very consistent…But [if he was dismounted] we didn’t end the lesson. and family members. So he wanted to get back on…so that’s kind of an example of…using that method that he consistently knew. yeah.screaming so he had to get off the horse…we just had to take him off because it was disruptive to everybody and he wasn’t doing what he was asked and… Margi: …how did he react to being taken off the horse? Shirley: He didn’t like it. do this”…very short instructions. or it is not stopped [he is taken off the horse]…In particular it was screaming for him…But the important thing was. it’s…redirect. but… Margi: …do you think he figured out he couldn’t scream on the horse then? Shirley: Uh huh. this is what teachers were using. But it took a while. instructors. two”— and if by three it is not been completed. Bob. Denise further explains the staff’s preplanned. one student in particular. When the topic of inappropriate behavior is raised. But what he wanted was the movement of the horse. I think eventually. say his name.

just answering back. biting. biting. “I think we can help him. Pat explains how the instructors worked to develop a coping strategy for his aggression toward his mount. while also keeping a record of the number of infractions he committed during each lesson: …you have this range of inappropriate behaviors that are both verbal and physical. “We don’t talk like that.” never say. So gradually we’ve started keeping an actual physical list of the number of times he said negative things on the horse and a list of negative things that he did on the horse. “Hm.” no n-words in the conversation.” and teaching those things.[I] watched her…repeatedly get nailed in the head by this child and I found it pretty doggone shocking when…the last thing she said to this mother was. Socie. Counting the number of inappropriate responses in a lesson and watching that go down and being replaced with more appropriate behaviors…But…it did actually shock me because he was so violent. petting instead of hitting. “Good Socie…nice Socie. pet Socie. And hitting.evaluation….” As Bob’s lessons progressed. but at the end…he actually started to ride in a lesson 157 .That was very measurable and there was a list for that…that was kept during his lesson. kicking…plus inappropriate language…And so you take…an adorable five year-old and stick him up on the horse while you’re trying to keep everybody safe and…not be injured…by this cute child and when he gets on the horse. I’ll have to look at my insurance again. and watching the list flip into positive things said to the horse…scratching rubbing. he’s just riding and hitting the horse in the mane and saying bad words to the horse and just over time watching the instructor.”…at that point I was thinking. never say. “No. thomping….

tickle session. with something out of kilter…over time it was a definite progression there that was heart warming and…good to see. gentle session.. he did it once.” Mary: And he would say that! Denise: Now his hit was not mean-spirited. He had to ride in a staff only lesson in case somebody got hurt. And…now. His way of showing affection was hit. Hit Socie. The instructors also recounted the behavioral modification process that took place during Bob’s lessons: Mary: . he was not angry. Hit Socie.. Denise: At least. And it sort of graduated to a volunteer-assisted lesson and then…we found…that he could ride with another child in the same lesson and—although… he still would maintain the capabilities to lose it and go off…with a change.with another individual. if I remember correctly. by the time I got him… Denise: 103 was the first count. Mary: At least – maybe a hundred?? You know.” (hand smacking noises)…his loving way of affection was (repeated smacking noise)…103 times in 30 minutes!! Mary: …the last lesson I did with him. Barb: (Incredulously) Hitting him?? Denise: Appropriate touch [from the child’s viewpoint] was: “Hit Socie. he 158 . it was one of us.when we started. it was my understanding that he was hitting Socie 60 times a lesson. And we have redirected that to – pet session. rub session. and as you said. measurable.

and very much the same…so he knew what to expect. no. but I know that he won’t be thinking about ‘Hit Socie. Nice Socie. “Pet Socie.doesn’t have time to think of a hit session. So he has to maintain his own body…up there and then…instead of all the restraint and all the language and all the yelling. You have to be responsible and you’re kind of up there…whereas if you’re on the ground…you can sit and lay down and roll around and somebody can come and grab you and hold you…but on a horse…you can sit up there and scream for a while and somebody next to you is just going to say. no. ‘cause we’re doing way too many things…And we’re doing rings. “No. Kiss Socie”…And after a while it’s those things that he chose to do.”…and all of a sudden…he’s on a horse.’ Lastly. I don’t know how this round-the-world’s gonna go. And I thought “Hmm. 159 . and we’re doin’ round-theworlds…and I knew that… the lessons had been…very sequenced. and we’ve got stuffed animals to ride. and we’re putting’ ‘em in mailboxes and we’re takin’ ‘em out. it really became…soft and gentle and good words and…I think that was about the best explanation that I’ve heard…You have to sit on that horse. Executive Director Pat offers her rationale for the riding team’s success with Bob: I think…he learned…watching the way that he was managed off the horse when he first came to us was…a restraint hold from your rear by his mother who took him down to the ground and then put him in a hug from the back and held tight through the kicking and biting and tried to ignore kind of what was happening and was constantly saying.

and he’s happy and he enjoys it.the benefit is that it’s helping him mentally…the biggest thing that I see is that it is. Steve’s mother is also grateful for the tranquilizing effects of riding class: As far as the benefits. We see where he’s had a really horrible day. And he gets on the horse and we go home and it’s like a whole new child…he loves it.. But I’ve always been able to get him to come…a lot of times he won’t get in the car and go anywhere when he’s frustrated…although tonight he really said he didn’t want to come but…I knew that once he came…it would help calm him…it’s very calming to him to ride the horses. focused. it’s calming. even keel. it really helps Steve mentally. 160 . does what he needs to do. he gets off the horse and goes home and it’s just like a typical. He’s…calmer after it’s done…we’ve seen some really good things come out of it…Bob can be having a really rotten day. When asked about any changes she sees in her son from therapeutic riding. His personality. family members of six children observe a more immediate calming effect when their child begins the riding lesson. Although improvement in individuals is often noted over a range of time.. Bob’s mother replies: …the biggest thing is his demeanor. typical kid.Calming effect. Rotten day being physically aggressive or just off the charts. and happy…we can tell when he’s not had Socie…we see a difference…we do see the temperament. It’s something he can look forward to…like tonight when I brought him he was very upset… He’d had a very bad day…a couple other nights we’ve come and he’s had very bad days and whenever he has bad days it takes him forever to calm back down.

And…so the movement of the horse…maybe mimics…his self-stimulating…so I believe that’s probably what it is that helps calm.Steve’s mother readily recommends this type of intervention for children with ASD. anyway…I think a lot of the…autistic kids have things that they do to calm. which his mother also credits to the presence of the horse: 161 . that’s not that he doesn’t want to be here. changes for the better were also noted once the clients arrive at the riding lesson: Shirley: Well sometimes we get calls…that they’re acting too bad at home to get them in the car…we’ve had a few…like that. it goes back to that emotional status of an autistic child is…so calming…the riding of the horse. Or they just had such a bad day it’s just not worth it.. Shirley: Yeah. During the first volunteer focus group. he likes that movement. Doug experiences frequent emotional outbursts during his lessons. Again. Some of them fall asleep. a couple times I’ve seen kids that were having a bad day and…it was a little difficult convincing them to get on. he’ll rock. Like when Steve gets upset. feeling that the movement of the horse is a possible key to the mood regulation phenomenon: …I would tell them definitely. The movement. Sherry: Yeah. but they have decreased in number over time. Alex.: If that’s the one I’m thinking about. That helps him calm. it’s just that they don’t want to get in the car. They were tired. yeah. it’s a program…worthwhile for the kids. But when they did they were fine.. You know. But once they get here. or whatever it is…has a very calming effect on Steve.

“…one of the ladies led the miniature horse…and… the other one would hold John’s hand…while the horse was walking. and then they get up there [on the horse] and they settle in… 162 . really hyper…it’s been a great experience for him…just because of how relaxed he gets…That is the biggest bonus for Wayne. and I don’t know quite what that is. John’s aunt notices a similar effect even when he was just walking next to the miniature horse in his lesson. and also credits the calming response to the movement of the horse: Shirley: And… some of them will come in. It’s really a neat. And he would watch the…little miniature horse’s feet walk…And he was real…happy and pleased and more relaxed. but there’s just… something inherently wonderful about a horse and a horse’s ability to help children. like really making a lot of noise. really. but it’s just a calming…when you can put a child on…and it’s something about their movement or something…just in their nature that is just…relaxing. but…he’s been doing so much better in that realm and…so we’ll take the occasional…rough night.” Wayne’s mother describes her son’s immediate response to sitting atop his horse: …[It’s] something that he can…enjoy and…it really does help him relax because he comes away and he just kind of sinks into the horse…He can be real hyper and he gets on the horse and…you can physically see him…just kind of melt. neat sight just to see because you know how hyper he’s been all— like today he was really. calming…and therapeutic. The first volunteer focus group members also noted this common effect in many of their riders.…that’s why this program is so good for him is because…he has less oral motor issues when he’s able to ride on a consistent basis. And…like tonight…he was— kind of keyed up.

Learning to deal effectively with transitions. Margi: …I’ve heard this thing about the motion has come up many times in talking to the parents. the ones that kind of have the hyperactive end of the spectrum will get into that. And it just puts him to sleep.yeah I’ve seen Neil fall asleep…on a horse.Sherry: Yeah. and very attentive to [saying] “Whoa” and “Walk on. But as far as some of the other ones…. where he’s more attentive to what he’s doing or what he’s supposed to be doing. Shirley: To the motion? Sherry: Yeah. Just the motion back and forth. At least the ones I work with. That seems to cut out. and seem to kind of level out. Bob’s mother is one of five family members who have experienced difficulty with their children in dealing with alterations from the normal 163 . is another important facet in the development of self-control. It’s just kind of falling by the wayside. or changes in routine. and one that is typically very challenging for a child with ASD. What are your thoughts on that? Alex: …not necessarily with Dave because he’s the one that I deal with that’s autistic…he’ll sometimes just have good nights and bad nights.” Transitions. And one little guy…goes off in a line of jabber…And that seems to have been…not as prevalent. and… Shirley: I think it calms Doug down a lot…I’ve worked a lot with him in the past and he’d just be having a horrible night and then all of a sudden he’d kind of…calm down… Sherry: I think…some of the ones make a lot of repetitive things too.

a temporary change in instructors. I think it interests him enough to try something different outside of his comfort zone. watch for the sign. I think that’s all that brought him…So we had to do lots of prepping over that…we had to make sure he was going to have Ms. we don’t like a lot of changes…I had surgery the end of May…which meant during that time either my husband [and] my mother. During the second volunteer 164 .routine. we were going to the right…Thank heavens they had the CKRH sign…It was like. Well. The roads and stuff…because he knew we came in. We’re on our way. Look Bob. Denise was part of the session. “…he normally wouldn’t like things that are outside of his routine or what he’s accustomed to. Routine is much better…We like routine. but being able to do the riding. So that routine and that consistency was missing. but various factors can require adjustment to a new animal. there’s the sign. Gary’s mother values the opportunity for her son to become more comfortable in new situations. And so.” Riders are carefully matched to appropriate mounts for their lessons and every effort is made to maintain that partnership. we turned to the left and we went and found Socie. “Look Bob. Mary and that…everything was going to be normal otherwise…we had to talk him through a whole lot of the driving when we were having to weasel through—when [the Kentucky Horse Park grounds] were under construction. and a modification to the normal entrance to the Kentucky Horse Park that was necessitated by construction projects. they had a rough time. She describes her son’s distress that was triggered on various occasions by different family members bringing him to class.” So he handled that…but now not too long ago…my husband brought him.

they do get in such a routine that anything that deviates from that routine. “O. To let them see that… Jo Ann: Change is ok. he rode DeeDee…So that’s what. He rode Annie for the longest. he’s been on…Annie. five horses?.let’s go.. he’s been on Goofed Off.K….In six sessions…And that’s surprising…Because for him. and something to go away from the norm is really usually really hard for him.like you said he wouldn’t have been able to have dealt with that change – just…two weeks ago we had some issues with our scheduling 165 . Perry: …there can be deviation and it’s not a bad thing. He rode Chico. and maybe even changing…leaders and sidewalkers periodically might not be a bad thing. so I think…by changing horses periodically. Wayne’s mother was pleasantly surprised to find how well he adapted to such changes during his riding program: He’s been on Red. Deb: The change issue. transitions. they really flip out over it. Perry and Jo Ann discussed changes in horses that are sometimes encountered in the lessons: Perry: I think it’s a plus…that they switch…because a lot of these kids..” Rick is quite dependent on a consistent routine in order to maintain emotional stability.focus group. and [the] first session he got on a different horse this time and he was just like. Instructors in the focus group gave an example of this capability and also described the team strategy that allows for his flexibility. but he has also learned to successfully deal with unexpected transitions in the riding program.

but…we got it resolved. but there is a certain structure. he gets the water. Now when it breaks down is if you think you’re gonna skip the step of getting the water. planning. two.he goes to the table. if you can keep the big picture of CKRH the same…He can adapt to the change in people. from the table to the mounting block.. As long as you can keep that structure. three. (Group agreement) Does he deal well with changes in horses. then everything seems to flow really well. and I actually had three different sidewalker volunteers come into the ring during his one hour lesson…I was really upset about it. he can adapt to the change in horses. Initiative. I’m not bothered!” Sounds like his focus has switched a little bit from…needing everything the same to…he’s got his horse.” Margi: It doesn’t matter! Barb: “If you’re not bothered. four–and.with our volunteers. or have you had that come up at all? Denise: He does fine with the changes in horses. What seems to be really important. he comes to the water. and I said. that totally. from the time he gets out of the car…the first place he goes is to the bathroom. “Do you remember Piper? You know. He gets out of the car. I remember her. One. totally throws him. Erikson’s concept of initiative appears in the early childhood years and involves the constructive channeling of energies into learning. but…he was fine! He was fine. increased 166 . and the third and final sidewalker was the girl that was supposed to be in there. assertiveness.. or if you’re gonna go sit at a different table. you had her last week?” “Oh. yeah. he goes to the bathroom.

dependability. we walked out of the barn. if she tries to eat. tell her to “Walk on.’ give her a tug. she always walked along beside us! And I said. She’s taken ownership.” and…she’ll maneuver out of the grass into the track. had the rope. and she’s taken command…I remember the first time when she was walking by herself. she knew exactly what she was doing. She wasn’t waiting on me. instructor Mary illustrates the progress Jan has made: I wrote in my notes – she has taken command of this miniature. As soon as early childhood. and off we went! And from that moment on. trustworthiness. so she’s not eating…this last lesson. we walked into the arena. children begin to learn morally-relevant behaviors through modeling and positive reinforcement (Berk. tell her to ‘Walk on. Use your muscles..” gave her a tug. “Well I think to be conscious…of just animal care and animal rights and…‘We treat animals nicely. and she went “Yaa. this was her mini. I turned to latch the gate and she was gone with that mini. walked on. and action-oriented activities (Murray et al. into the sand. Dave’s mother remarks. she will give her a tug. Moral development and responsibility. Jan’s remarkable journey from fearful reluctance to enter the barn to willing and capable involvement is noted by her instructor as well as her parents. When asked how she has viewed her son’s improved riding skills and maturation over time. During the focus group. and Merrylegs stopped to eat…It never occurred to her that she [the horse]wasn’t gonna walk right along…there beside her…because when I was leading. and responsibility. 2009). “Well. and by middle childhood should exhibit basic traits of independence. 2004).’…those kind of things are always good for 167 . she’s not supposed to eat.

Potentially satisfying goals must be viewed as attainable but also challenging enough to render their accomplishment rewarding. There’s another animal…that needs care as well…And some responsibility involved with it so. so he’s now getting the sense that…it’s not like your car…It’s not something where you just sit down and it goes…you have to maintain it and…there’s another being there. task mastery. One of four family members who spoke to this construct.” Rick’s father senses that his son’s attitude toward his lesson horse is maturing: And…within the past year. and so that’s been 168 . defeatism. Industry.. and a reluctance to attempt further pursuits. Related concepts not yet discussed include challenge. 2009). And she knows that she’s doing something new and different and challenging. they’ve also incorporated some tacking and horse care…with it. Jan’s step-mother describes. and task mastery (Murray et al.” Brian’s mother attributes his progress to his placement in appropriate classes of increasing difficulty: …part of that has been in making sure he’s in a class that’s…challenging him and slightly stretching him without not trying to overwhelm him. problem-solving. Failure to realize this goal may result in feelings of inferiority. so it’s been wonderful. Challenge.anybody. “She has been so sheltered and unable to do so many things that it’s like…her chance at soccer or her chance at…some kind of sport. 2004) through perseverance. Erikson’s construct of industry includes the pursuit of meaningful achievement (Berk. and participation.

Brian has participated in the Special Olympic competition held on the grounds of the Kentucky Horse Park but in a less familiar location than CKRH.some of his best moments. I need you to touch the horse. Task mastery. “It was held here…at the Horse Park. And that was a big deal. yeah. “’Jan. “…he gets better each time. While noting that finishing tasks is a typical problem for her.’ And she might protest. so something that motivates—if they’re motivated by it…that’s very good for them to be in a new place…[to] experience new movements and new smells and new people and be challenged to do things beyond their comfort zone.’ or ‘We’re going to brush this horse 10 times.” Rick’s father did 169 . task completion. Four family members reported their children’s growth in the area of task mastery. CKRH instructor lesson plans state specific skill objectives and client evaluation forms record the degree of personal goal attainment for each lesson. but she’ll do it…which I think is just wonderful. as his mother explains.” Kerry’s mother believes that he has progressed as he has learned to successfully control horses that require more skill.” Gary’s mother recommends therapeutic riding to other parents because: …I think it’s good for any autistic child…because [of] the sensory sensitivities and that kind of thing they may be less likely to try new things or be in new situations. but it was over…in the bigger arena. whatever the right word is. and then…encouraging him to participate in…some of the other…programs that’s available. Jan’s father mimics the riding lesson instructor’s directions that promote this. so I think they want to challenge him and give him a horse that will challenge him a little more.

Denise said…this isn’t a gimme… he has to work towards it…and I’ve…conveyed to him that he has to work and he’s done wonderfully…especially in the last year. “…he’s learned to…tighten up the saddle and adjust the stirrups and he can get on…by himself…And…he’s ridden by himself without a lead…” Dave’s mother adds: …I think this…helps build his skills… because they practice a lot of stopping and starting and it seems like these last two or three sessions…they’re into the…turning and the control of the horse so that’s improved over the years. or at least I did for him…of the Special Olympics…which he’ll be riding in next week…and he’s earned the right…Ms. allowing him to ride purely for enjoyment. 170 . so I think that’s good for him to have to process…what he needs to do to control the horse. he’s really…moved beyond just riding to really trying to learn the skills and whoas and stops and starts and rights and lefts and leading and steering the horse…he’s really blossomed his skill sets… Parents appreciate that the classes are structured with individual client progress as the goal. he told him: …Rick. Because…when they start out down here. and that’s always good for anybody to have to think about what to do. I think…the skill building part of the program has increased. but after the first five years. you’re getting like me. as described by Dave’s father. You’re a little lazy…so…we’re going to push this and…you’re going to learn some skills…So…we set the goal of. these kids just have the…[side]walker so they don’t really have the skills.not initially emphasize skill attainment to his son.

we’re going to move him up. where the students typically ride without as many volunteers to assist them. So I think he’s actually going to become a rider now. too…aspire to…higher riding levels… Margi: Where you don’t have to have all those people around you! Mary: Right. and there he goes riding by. yeah! (Group laughter) 171 . look at him”…then he blew me kisses and said.” He’s obviously very confident now on the horse. “Oh. rather than just…doing…mostly I think therapeutic skills..Kerry’s mother has been very impressed with his rapid improvement and appreciates the staff’s concern for continued advancement: …he was standing in a jockey stance.K. so I thought. The motivation for clients to be promoted to instructor Alan’s class. and he’s learning more skills. going around the ring. yes! Denise: Oh. was mentioned often during the instructor focus group. “O. they’re teaching him more. Margi: Do you feel the kids are aware that Alan’s class over here rides independently. and…they really want to master that skill and bump to the next skill. “Oh. I was like. and the rest of them were…barely trying to sit up still. is that something… Mary: Oh. And he’d stop and give us a thumbs-up as he was standing up. Here they discuss the difference between Alan’s riders and the non-independent student riders: Mary: I think your guys.” So I was like. look at him go!” But they said…when he gets a little bored in here. they’re giving him more responsibilities. “I love you Mom.

Mary: “When can I be in Alan’s class??” Margi: Ah. that’s it. right…so that’s the best I can do in one word…And I think…one of my struggles. When asked to describe the single most important benefit she has received from the therapeutic riding program. Jan’s father replies: …I see so many good things…but…just the participation…for her to be learning this skill…and to be participating. and identity formation.” Rick’s father’s initial main objective for his son to participate at CKRH has been fulfilled: 172 . had always been that she has enough structure and programming in her life outside of school. Children with ASD classically exhibit little interest or willingness to take part in such activities and therefore miss out on opportunities that are commonly available to their peers. “I think just a structured activity you have to look forward to. Participation in activities and organizations that are meaningful to the individual is an important building block for many constructs such as achievement. as indicated by nine family members who appreciate the significance of this activity to their children. it’s a little carrot out there… Mary: Exactly. Dave’s mother feels the most obvious benefit for her son is. emotionally. task mastery. exactly Steve’s mother has witnessed the progress her son has made since moving into one of Alan’s more independent riding classes.” Participation. self-concept. “So…Steve has thrived on that. So just having an event every week to look forward to…I mean it’s one more thing to make her life that much more full.

Despite suffering an injury in a fall from his lesson horse. I mean. helped us with his planning of time and days. horse. But she’s going to be able to do this…I can’t imagine her not having it. I think if she couldn’t I think she’d be devastated. Doug’s mother felt he was upset that he had to miss some lessons: And…in his own way.My expectation at the beginning was basically an outlet for Rick to do something that he just enjoyed…that he’d look forward to… something that would always make him happy because he always was…and always is still…That he actually looked forward to it. this has been the one constant that he’s always looked forward to…very little has kept him off the horse. ride. I better get him in and get him here fast. “Ride.” but…you could tell he missed it… Meghan’s grandmother notes the importance of having a special interest or hobby: …it’s like a child that can learn music…it’s something you give them that no one can ever take from them. you could tell he really missed it…of course [his older brother] Brian was still very involved in riding and we came out and I can’t remember if he [Doug] was saying. he’s really disappointed…and if he tells me I’m sick. if he’s not interested in coming here. Well she’s not going to be able to play music. I think it would just be devastating. “Horse. If he doesn’t get to come. Jim’s mother feels therapeutic riding has become a staple of his weekly routine: …the one thing that we’ve never had an issue is with him coming out here. I really do. I know I better get him to the doctor. 173 .” or.

They feel like outsiders and that they don’t fit in. “It’s something that’s his own. That’s what’s so special about it. Conveniently. His mother has implored him not to worry so much because “it doesn’t matter.” Wayne’s mother explains that their initial goal in attending the program was “just to have fun. for some it is horses. So don’t worry about how you do. Give him something to have that’s his. as Jim’s mother emphasizes: 174 .” It is common for children with autism to have a particular area of interest on which they focus. Just go and have fun…” Another related CKRH event that some of the clients are asked to assist with is the annual Night of the Stars gala.Steve has previously taken part in Special Olympic swimming competition. he is concerned about being adequately prepared for the show ring. This added bonus was identified in the comments of nine parents such as Steve’s mother. And so I think that kind of stuff makes him feel good because he enjoyed that…he was excited about that because he likes to dress up and he likes the horse and seeing all the other horse in costume. Having the opportunity to gain proficiency in an activity that is a relatively unique and is of particular interest to the child can contribute to the concept of identity formation. Although he is looking forward to the event. just go have fun…it’s just the thing that you get to participate. Identity formation. but will be participating for the first time in the equestrian division of that event later in the year. He owns it…I think most kids [with ASD] face the same thing Steve does. as Dave’s mother describes this as a valuable experience for him: He’s participated in their fund raiser two times.

That’s a struggle. in the real world! 175 .” Not “Momma.…Jim’s obsessed—one of his obsessive compulsive things is about horses and he loves horses and it just so happens it’s something that’s really good for him too…His first word was “horsie. according to her mother: …but from the moment the first time that she rode she was happy on the horse and…it was really the first time she had shown an interest in…something besides. And she dearly loves it… This topic was also mentioned during the instructor focus group: Margi: And not everybody can ride a horse. But she’s going to be able to do this…This is her thing…And how many people…can do that? She’s got something. Meghan’s grandmother echoes those sentiments and further notes this is a unique skill her granddaughter is cultivating: Yeah. of course. She became very interested…the riding therapy fits that important part that she has an activity that’s hers. immediate family. that she can excel at…I think the confidence and the sense of normalcy that it brings to Meghan. There is something that Meghan can do and Meghan can have as just hers and she can improve at.” “horsie”…Jim’s thing is horses…He likes all horses…he follows the racehorses to some extent… For Meghan.” not “Daddy. it’s something you give them that no one can ever take from them. Well she’s not going to be able to play music. discovering the world of horses provided an area of interest where before there had been none. [Or] an inanimate object. yeah. as we all well know. it’s like a child that can learn music and once they learn it.

I don’t ride a horse. well a lot of kids play soccer. You ride a horse…You’re not scared? You don’t think you’re going to fall?” And he’s like. “No”…And so he’s very proud of that. because…everyone can play. in that skill… Margi: To the average Joe Alan: To the average person. not even their parents ride… or their siblings. they’re so impressed with that…And he’s like. And of course. any kid that you see come here get out of that wheelchair and that’s the only time 176 . Barb: Well.” And they’re like. even in horse country here”…but this he knows he does well… And people get so impressed when he tells them. Some people are scared to death of horses. which his mother feels is a benefit readily shared by any of the clients with disabilities: …and he gets up there and stands like a jockey and he wants to do it and he’s good at it and his peers are not…he does something that they’re not able to do…So…just the confidence that he has from coming here. “Wow!” You know. “Not everybody rides horses. a lot of kids play basketball and baseball but he’s…one of his only friends that ride a horse.Barb: At least not well [group laughter] Mary: In fact. and I think it reinforces it…like… “Oh. I think that’s even more so…because now they’re actually superior. “I ride a horse. “Yeah. I ride”…and I say [to him]. Kerry’s mother has witnessed the reactions her son receives when describing his riding accomplishments to non-riders: And…he tells people. “You do?”…they’re like. Robin excels at an activity that most of his peers do not.

he’s good to go. I mean he loves it. she totally loves it. I don’t think there’s any doubt that she loves it” and she concurs. and he’s excited on his way home…it’s an overall…love of his.” Enjoyable activity that makes child happy. When asked if her son has gained any emotional benefits from therapeutic riding. Kerry’s mother provides a succinct response.” Jan’s father compares observations with his wife.” Wayne was an early convert to riding. thrilled to come… I think as soon as you say we’re on our way to the Horse Park. he’s excited while he’s here. 177 . what a great place for them to be…kind of isolated from their peers and to be good at something that other people aren’t good at. And she loves Ms. “I don’t know what she’s said with you when you bring her. And he’s excited in the car on the way here. “Oh my gosh. “Oh. He looks forward to it every…Wednesday.they’re independent and I think. every family member interviewed describes the value of therapeutic riding as an enjoyable experience for his or her child. Jerry’s mother has frequently witnessed his reaction to his riding lessons: Jerry thoroughly enjoys coming here. as his mother recalls: And he was really excited about it too…so for him to get excited about something was a big deal…So it was really…fun…He got on the horse the first time and just didn’t want to get off…he loves it. Whether the child is horse crazy or just takes pleasure in the riding experience itself. There is no fear…He’s thrilled. Mary and she loves the Horse Park. “…Just happy…he loves—he just loves it.

“. For many of the children. as Rick’s father indicates. let’s get our jeans on and let’s go. but his mother feels the CKRH program has been more structured and beneficial.. his mother now concludes: …we use it as therapy. Well..So…he feels real good about it…but…even though he’s had some bad days…I’ve still been able to get him here.. It’s not been a bad experience.” and…he never has said. This activity…I just think the time he’s on the horse.I mean if he wasn’t having fun. he totally enjoys his time with the horse…and it’s fun!. riding is their favorite activity. It really does…he has really enjoyed it here…” Even though Bob’s aggressive behavior toward the staff and his horse provided some tense early moments.Steve had previously ridden in a therapeutic program in another state. that tells us a whole lot because he lets us know when he’s not real happy… Dave’s mother also partially gauges her son’s level of enjoyment on his willingness to return to class each week: I think he’s always liked coming…This is one that he’s liked to do…every year. he wouldn’t want to come back…I don’t think he has any negative thing…because he’s never said he doesn’t want to come…it’s just like… “It’s time. “He has ridden in every session that’s been available to him…because this is one of the things that he loves the most is riding horses…as long as he’s riding he’s 178 . “Oh I don’t want to go”… So he obviously enjoys it. That says a lot. Once we got through those first couple weeks…he loves it…it’s not a fight to go there. but it’s also something that he does that he enjoys that a typical child does…It’s worked for him. he’s always ready to go..

happy…All he wants to do is ride.” Jim’s mother appreciates that he has a preferred pastime: …this is the thing that he gets the most out of, in terms of enjoyment…this is what he likes to do. This has been the most consistent thing that he’s wanted to do…it’s an interest and it’s good for him. I’m glad that he’s got something…that really interests him to that extent… Meghan is another one of the children for whom horses are a passion, as her grandmother confirms: …she was just tickled to death that she was able to come out here. And…she’ll take as many [riding sessions] as she can get in the summer…her love for the horse is the best—just phenomenal. She…just absolutely loves it. She’d come three times a day. She’d stay all day every day. She loves them that much… Everything is horse, horse, horse…there is something about a horse…she just absolutely loves…But this is her world. She’s got horses all over her room, all in the drawers, all her clothes has horses…And she has the love. She has the love. Many children with ASD do not clearly communicate their likes and dislikes, but family members can often distinguish behaviors that indicate a positive response to their therapeutic riding classes, as Gary exhibits to his mother, “Yeah, I think he really enjoys it…he would…voluntarily run up and get his helmet on and seem excited about doing it so I think he enjoyed it…” John’s aunt reports similar actions: …we can say in the morning, “John, we’re going to go…to the Horse Park today,” and he runs and gets his shoes and his…car seat and all that. He’s

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ready…Hours before we’re supposed to go. And when we turn into the Horse Park gate, he starts squealing and he’s just like so excited. Due to Brian’s more superior communication skills, his mother can readily ascertain his continued interest in the riding program, but his brother Doug’s reaction is harder to interpret, “[Doug]…enjoys it and…it’s hard to find something, at least that I can know unequivocally that Doug enjoys…because we do struggle…he can’t communicate his wants and needs, but…you can determine enjoyment in other ways other than words.” It is easier to judge the program’s effect on her older son, as “…with Brian…the success stories with him…have been more apparent…his challenges are…a little different…than Doug’s, but…not as severe, but it’s been beautiful to see him…progress, and some of his greatest moments have been associated with this program…” Coming into the CKRH program without anticipating specific goals, the boys’ mother has come to consider this a valuable complement to their other interventions: …I was just thrilled to get in and get them going and just kind of see how they [did]…so I didn’t have a lot of expectations. I just wanted them to come and ride and see if they would enjoy it and…then I could kind of slowly start seeing … “Hey, this is beneficial for them”…but…if they’re enjoying it and they’re having fun, to me it’s beneficial. To me it’s worth it. The volunteers who work with the children readily identify with the children’s enjoyment, as expressed by Sherry in the first volunteer focus group, “Oh…it’s so wonderful…you see these kids coming off happy…seeing the joy they’re getting.” During the second volunteer focus group, Jo Ann further elaborates on this theme:

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Their parents will tell you that’s all they’ll talk about all day long. If…they’re there on Wednesdays, they will get up on Wednesday morning saying, “Let’s go to the Horse Park; time to go to the Horse Park.” Until…they go to bed at night…And that’s all they talk about after that, like “I can’t wait to go back next week,” so I know the kids enjoy it…I know a lot of them have been here for a really long time and I don’t see them stopping any time soon. Certain class activities or exercises in particular often elicit very positive responses in the riders. Performing Around the World, for example, requires the rider to shift his or her forwardly seated position to face to the side, then towards the tail of the horse, and then to the other side before returning to face forward. Bob is one of the riders who enjoys this exercise very much, as his mother describes: …he does lots of the riding forward, riding sideways, riding backwards. Whatever they call it—Around the World?…he does that, which…he thinks is hilarious. And the other day they had him hugging the horse’s tail… he was laying backwards on the horse…But he was happy. Another more advanced class activity that many children enjoy performing is the gait called the trot, when their horse is asked to increase its speed from the walk. Until the client learns to properly absorb the added impulsion from the horse’s hindquarters, this can provide a very bouncy ride, which most children find quite entertaining. As Rick’s father relates, “…he likes to trot…and he laughs and…got a big grin when they trot. Meghan’s mother concurs, “I’ve heard people that hear her laugh when she’s trotting. It’s just a belly laugh. I wish I could record that. Yeah, it makes her laugh. She really loves that…She loves to be on the horse.” Wayne’s mother appreciates watching her son

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trotting, “…and when they trot, just to hear him laugh. I mean, he giggles every time. He just loves to trot. So just to… see him happy…and to see him truly enjoy something…” In the first volunteer focus group, Alex and Shirley described the responses of their clients to trotting: Alex: …the one kid I do with Alan [Steve] and trotting, the faster we go the more he likes it (group laughter). Shirley: That’s typical of all the kids. They’re all grinning like little infants, you know, trotting…most of the ones I’ve worked with are just tortelling [sic]. The second volunteer focus group echoes a similar sentiment: Perry.: …and what I tell everybody is when you see these children on these horses’ backs and they trot, I mean… Jo Ann: They’re so happy. Perry: They get so happy. They laugh. I mean some of them laugh so hard they can’t catch their breath. And to see that kind of happiness in those children…it puts them on an even playing field, or not necessarily even, maybe up. Family benefits. The condition of ASD naturally affects many more people than the affected individual alone–most notably the parents and family members of the child. Although the original research proposal called for an examination of physical, cognitive, social, and psychological benefits of the therapeutic riding program, the data were replete with a wide array of benefits provided to family members of the participants in addition to the personal insights provided into the phenomenon of raising a child diagnosed with autism spectrum disorders. This section will examine advantages provided to parents or primary

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caregivers and other family members as a result of the child’s participation in the therapeutic riding program. Parental challenges. The diagnosis of autism spectrum disorders. Several parents such as Robin’s mother describe the process of becoming aware of their child’s developmental symptoms which eventually led to a diagnosis of autism spectrum disorders: …the only diagnosis we had was hypotonia…he had what’s called a true knot in his cord…And so we originally were really worried that he had CP [cerebral palsy]. And so I was very conscientious of this and I always watched…fortunately for him, his mommy was an OT. And so I was constantly working with meeting his milestones. Now he never missed any, but he got them at the very end…Everything was at the very, very end of the spectrum, when he was supposed to gain the milestone. So when I would go to see the pediatrician, on those days, he’d say, “Well…he’s rolling over”…So technically he wasn’t delayed yet. Even though, you know he was. And…there was so many things that kind of added up. Where he wasn’t talking. He did say “Mama” and “Dada” and “Uh oh.” But I don’t think he knew who Mama and who Dada were. We were constantly in his face going, “Mama.” And so I think he…just copied that. And the same thing with “Dada.” But I don’t think he knew what he was saying…he really just seemed like a really easy child because he wanted to be left alone, he wanted to do his own thing, and where he had a twin, I was busy with her and she was more needy and more demanding. She probably was just a more

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typical kid because she was constantly coming over to me and showing me things and wanting me to do things with her, and he never did. And, of course, that’s one of the symptoms of autism, is that they don’t bring things to you and they don’t want you to gaze at things with them. They don’t show you things, they don’t point at things…And then…one of the more obvious things, of course, was that he didn’t respond to his name. I could sit six inches away from him and yell, “Robin, Robin, Robin,” and he would not look. But I knew he could hear because he’d hear the phone ring and turn toward it, or he’d hear the Wiggles on the TV and come running. But…socially he just didn’t know, when someone says your name [you should respond]…and then… when you go to pick him up, he’d stick his hands and legs out. He did not want to be picked up… Gary’s grandmother communicates the struggle involved in her communication efforts with her grandson: …it’s really hard…I raised several kids and…when I talked to them and explained things, generally they understood and they would do [what you asked]…but you can’t do that with him…so it’s like I’m not quite sure how to reach him…I wish I could find a way to reach him…So I haven’t discovered it yet…but that’s the frustrating part. It’s like if you could just reach him… Family members are understandably resistant to acceptance of symptoms suggesting a potential diagnosis of ASD, as described by Kerry’s mother: See, my mom doesn’t believe he has any of these issues at all. She doesn’t live here, so she doesn’t see him all the time. And she doesn’t see all the awkwardness. Now my dad comes up a lot more than my mom does, and…he’s

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“Well. Robin’s mother commonly comes into contact with parents who would prefer to attribute their children’s developmental delays to conditions other than ASD. So he did have some fluid in his ears.” Interestingly. “But…he’s saying some words. So we could kind of make excuses for his behavior and think. “Oh no. He’s just going to grow out of it”… In her work as an occupational therapist. but experienced difficulty convincing his pediatrician of the need for early intervention.” He goes.” I said. “Well. you know what’s really emotionally scarring is that he talks to kids and they don’t understand him and 185 . “Well. But my mom’s like.’” and he can’t even repeat it back. That will be just too emotionally scarring for him. And he believes it a little bit more. maybe he doesn’t have autism. you don’t want to do that. parents sometimes encounter resistance in their efforts to attempt to correctly diagnose the condition with their child’s own physician. and then…he did have low [muscle] tone.seen it. I really think we need speech therapy. but really he’s not…like he says ‘Momma’ and ‘Daddy’” but…then you say. as she recalls: I’m like.” And I said. did you understand what he just told you?” And he goes. “Well. “Oh he’s going to grow out of it. Kerry’s mother had noted abnormalities in her son’s speech development. He’ll make a sound of a monkey but he wouldn’t repeat it back. My pediatrician. he [Kerry] …could barely…talk to him and…I would say. as she herself initially did: …a lot of people with children with autism will initially think that they’re deaf because they’re not responding to their names…They’re not talking. “Not really. say ‘monkey. “Well. And then…he was four and a half.

”…I’m like. if you knock those out. “Oh. and…no one…his OT wouldn’t really say…and it wasn’t real obvious. but no one else can understand him and it was so frustrating and so I had to just say. and then I’ve had people go there and then even not really pick up on this. And to him. he’s ADHD. And I would say to his pediatrician… 186 . “Oh. and then he did have fluid in his ears. Robin’s mother experienced less resistance from his pediatrician when she mentioned what she felt were his related symptoms.they walk away. he sounds perfectly fine. He made good eye contact with his pediatrician. there’s a lot of characteristic that are very similar and…sometimes these sensory things. he was a really good doctor. And so that could be confused sometimes with autism…I had memorized. the DSM [Diagnostic and Statistical Manual] and so I knew. it was very suspected that around 12-14 months.” I said. just I think a little misinformed…so I was really confused. when do you think he would outgrow this. and I think they’re teaching doctors now more because…we don’t even…have a developmental pediatrician here. “I’ll deal with the emotional scars later. “So he’ll have to be nine before people can understand him?” Anyway. by then.” And he doesn’t understand. I could make…a mental checklist and say…all three of the categories I knew…I could check them off. They [say]. but still struggled to get referrals for both early intervention therapy and an eventual screening evaluation: …Well I pretty much knew. He knows what he’s saying. that ADHD part goes away. like by nine. You gotta go to…Louisville or somewhere else. “Well. if you think he’ll outgrow this speech impediment?” And he goes.” Well. He had these low tone issues.

so I went ahead and got him on the waiting list and so we couldn’t get him in until. you know. And then Vanderbilt was only six months. “O. “Well. well it set me on edge big time because I’m like. And. four maybe. “You know what.…prove it. And we got the diagnosis…But. but he’s probably going to have to be institutionalized as an adult…And it’s the kind of stuff that just.” And…he reluctantly gave me a referral to therapy because I thought. I’m going to take him to Vanderbilt to get the diagnosis.K.“I think…” and I would go in crying and saying. “Well. prove it!” Well. “O.K. I’m like. there is currently a much greater awareness of this condition. treat the symptoms… Although it still seems challenging for families to obtain a timely diagnosis and appropriate treatment. so you can’t prove to me why he’s going to be this way because…”…Well. but it was like a 9-12 month wait. As the mother of a young adult (age 23) who was first diagnosed two decades ago. he had done…EKGs and different tests and…MRI’s and nothing had showed up as being abnormal. Jim’s mother’s early experiences differ from those of the younger participants’ parents: …he was three. what…is therapy going to hurt?”…and then…at 18 months I finally just said. Because I knew…we have [a children’s center] in Louisville. of course I did get him an intervention before. I talked to another doctor later who had gone to school with this particular doctor and he said. like you were saying. something like that…when…a neurologist told me…do the best you can. “…I’m so afraid he has autism…or at least PDD [Pervasive Developmental Disorder]. they used to tell us at med school to 187 . it was almost 26 months before we were able to get him in.

you just continue to face new challenges. Family members such as Gary’s grandfather freely articulate their emotional responses to the child’s diagnosis: Well…we’re amateurs in this whole thing…we were in grief.” which is foolish. “Yes. the doctor said there’s nothing we can do.” and they just let it go.tell parents that. We don’t measure it versus other kids of that age or this or that…We just measure it against him. but how many parents…would just take that and not even try?”…I was just horrified…And I know that there are parents who do.” Meghan’s grandmother describes the anguish elicited by the inexplicable alteration in her granddaughter’s development. But he’s made [progress]…a little bit at a time. her grandmother continues: 188 . Reaction to diagnosis and grief issues. and then if it tuned out for the better then it was because you’re a good doctor. look at all the things he’s doing”…we’re very happy with the progress. Gary against Gary as he was and what he’s doing now… Jim’s mother speaks from several years’ more experience with her 23 year-old son. it left…Unreal. unreal…” After depicting a frightening incident during which Meghan wandered away from supervision. ‘This is this’…and she’d just point right at it. They say. And…I said. “Well. initially once we realized what the condition was. ‘Mom. And …that just…doesn’t set well with me. “But to see that little thing at six months old saying. new developments as your child ages. obviously. And then what happened? Just. And it’s…cumulative…we say… “Compared to this time a year ago. “The grief cycle never ends. I think.’ and she’d point out pictures and she’d say.

and until I saw the kid on the show doing the hand flapping. So hopefully…it has scared her a little bit…and she doesn’t much want to be left too far alone. And I was like. “You’ve got to be kidding me. She said. because she was like.Now that hurts because you can’t help but have hope…that she’ll get better.” And…[her friend and CKRH peer parent] Sally. “You know. 189 . But when that happens. surely it’s not really that”…It’s just…a roller coaster ride…And I feel like…there’s a light at the end of the tunnel now. But now. where before I didn’t know. I did not realize that my child was doing that. it’s like it brings you back to reality again…It’s not going to happen. I kept hoping that maybe she would do a little better... like…“I saw kids doing that. being the OT…she was telling me things. But…that’s a very hard thing to accept. It hurt her so badly.” Kerry’s mother had the benefit of increased media awareness plus her friend’s background in occupational therapy during the process of recognizing and accepting some of the early symptoms of ASD in her son. It really hurt.. it has affected her some in that she didn’t want to go out to pick up one of her little scooters that her mom told her she had to go get it because she’d left it somewhere. “Well. unless her brother went with her. Casey” …but then she was a little bit in denial too. you know…They don’t think the same way. And it’s very difficult for her mother. but…I don’t think so. such as stereotypical movement and the calming effects of physical pressure: And the Today Show did a show…I think it was a few years back.

So he’s modified his hand flapping to tapping.” then she gets upset and then…she gets more upset and then…there’s no calming her down…And so she just really had a meltdown. As an instructor. Family members must deal not only with their personal responses to their child’s condition. [demonstrates abnormal movement] …in fact one of his friends even told him… “I really like the way you tap on things”…. but his mother describes how he is learning to adjust these behaviors: …I see him.” and then all of a sudden I’ll see him in the corner doing his little flap dance and his little bouncing and he’ll come to me and now he’s got this little thing and I call it his little tick…like before he talks he’ll go. They’ve not been there.Reactions of outsiders. “You ignorant…You’re just ignorant. And…I remember these people walking by and saying. Kerry displays intermittent stereotypical movements that readily call attention to his condition. she wants it and if you say. they don’t know. “You need to wear her out”… and…I thought to myself. Deb is keenly aware of the general public’s lack of understanding of ASD: 190 . “No. I think. Meghan’s grandmother recalls an upsetting situation: …we went to a yard sale one time and…[Meghan] had a meltdown…she was going along and she was just fine. They don’t…Not a clue. You have no concept”… And you just have to overlook people like that. but also to the reactions of strangers who are unfamiliar with the abnormal behaviors related to ASD. He looks like a normal kid. but sometimes she gets stubborn or she likes whatever. “God. he looks so normal.

“Oh. and it’s like we’re talking about two different people…two different types of individuals.”…but when you see somebody that you can’t look at them and tell that there’s something going on. then for parents and for them. and that these children are never going to be socially interactive. you don’t see him in a wheelchair. their perception is that is a hopeless diagnosis. Program Director Denise appreciates the additional stress placed on family members and the concept of victim blaming caused by the inability of many persons to readily recognize and empathize with a person who has a behavioral rather than physical disability: …it goes back to whether it’s a diagnosis of autism or a mental health diagnosis that is not apparent when you physically look at somebody… when this adult…or teenager…is walking down the halls at school. which is really sad…So there’s a lot of blame…there’s a lot of expectation of if you did this differently…you would behave differently…you must be a bad parent. which is not good either really. And I tell them about my experiences. everybody says. you don’t see him on a cane…whereas if there was a physical disability population…the response might be. but…there’s kind of an “Aww. it’s a behavioral issue. “Oh.” or sympathy. You must not be disciplining your child…or they wouldn’t be behaving this way. 191 . you need to…discipline your child”…People don’t understand so they…look differently at them I think. But to them.…I’ve talked with people who don’t…interact with people with autism.

Brian and Doug’s mother also addresses the frustration she has felt: …there’s no handbook out there…when you have a child with a disability that says… “Hey. they’re fighting. gosh. and this. With minimal support and advice from their pediatrician. I don’t think anything I’m doing is hurting him. even. they’re fighting a system. Like 192 . this. and here’s their websites or here’s their phone numbers”…You’re just kind of left to…find out all this stuff…find your way.” While discussing how glad she was to be able to profit from the therapeutic riding facility’s program. That’s really unfortunate. you ought to try this. Kerry’s mother has taken the initiative to work independently with her son while actively seeking out potentially useful interventions: …we’ve been giving him good coping skills…And I can’t help but think that that’s not helping. I mean. and that’s too bad. finding it necessary to rely on suggestions from parents in similar circumstances: I’m working on trying to find out what I can get for him…and I’m really bad about knowing what’s out there. this. Wayne’s mother has found little guidance from physicians or school resources.Proactive parents have searched for effective interventions. Instructor Denise has witnessed the need for family members to be proactive in seeking out information and appropriate interventions for their children. trying to obtain services. unfortunately…you have to talk to parents…to find out what’s out there…like the schools don’t tell you and doctors don’t necessarily know. So…it’s by word of mouth. “…so many times and so many different places. They’re fighting to get in the school systems…they’re fighting with the insurance companies to get them to pay for services.

my doctor is confused on what’s going on with my kid and I can’t…seem to make him see it so I’m just going to have to act on my own. but also from her early course work and classroom experience as a teacher. and I kid you not. “Well he’s doing this.” or any kind of…update the OT does on him. What do we do when he does this?”…But the doctors can’t get together and. I…was part of the 193 . especially with all the autism. are the one who has to go out and deal with it…and you feel awkward and you don’t know what you’re doing because you don’t really understand it yourself. …Well actually that was one of the biggest disappointments of my life. and I send him everything.my doctor was so worried about me giving him therapy…And that blew my mind…that’s when I totally started challenging—I was like. the parent. especially now. I think there’s people out there. I mean Autism Speaks…has been wonderful… Jim’s mother has had the opportunity to view the dearth of factual data on treating children with disabilities not only from the perspective of a parent. “Oh…kids will be kids. how’s this riding doing? Send me stuff on it. I send it to him…but he still…won’t ask about it…he’s still like. And if you’re willing. He wants to know. now my doctor since…I still go to the same group. Read a book on how boys are bad”…you. After Robby…got into kindergarten…before he did. “Well. He’s like. You just go out there and then you just find it. “You know what.” And it was really hard and I went to Cardinal Hill and I was talking to all these therapists and no one would get together and…I was like the coordinator and I was like figuring out what he needed and I didn’t even know what I was taking about…except I knew what was going on with him and I could tell them.

they’re like.’ So I’m like. And…when I went…I had these high expectations of walking into these college classrooms.. Jim was just getting out of preschool and getting ready to go into kindergarten…and…after he got started in school. When they passed KERA in 1990..I thought it was just for people in wheelchairs…But. “What?! You’re not giving me what I wanted here!. Anything that we can do. I had an opportunity to go back to school to become a preschool teacher... this is how you teach them. Anything we can try differently or…just any suggestions. a recurring theme is communicated by most of the family members regarding their search for useful interventions.push for the KERA preschool program that’s in the schools now. Thanks to the lack of a generally-accepted course of action for treating children with ASD.. if a child has Down syndrome.” Kerry’s mother was surprised to learn the therapeutic riding program was available to her son. If they have cerebral palsy. masters level classrooms and [them] saying. “…the parents have tried…a number of things. And I think I’m a pretty good teacher and I think a lot of it has to do with my experiences with Jim. they did. well let’s try 194 . They haven’t spared any effort…And we would always like to know…what additional we can do. ‘Oh no. as much as any education that I’ve managed to get along the way…but it was…a shock to me to find out that…they haven’t figured out…exactly how to teach children with these disabilities. After describing his and his wife’s efforts to take Gary to museums and other venues.K. “. and I was just horrified. “O. his grandfather stresses. which is what I am. you could do that too.You don’t know? You’re not the experts here?”…And it’s not that they didn’t help me. this is how you teach them”…[but] I was like.

Honestly. or I can be selfish. her mother was grateful to find a constructive outlet for her within the therapeutic riding program: …We really didn’t know what to expect actually…when we heard that there was even such a thing…it was just a matter of putting her in an activity. So we didn’t really 195 . though…You know you asked about expectations for the program. Something that would be appropriate for her because it’s not very easy for children with these disorders to fit into…a regular riding group. And it was just kind of the thing that if somebody told me that it might work. which is…to chase down the therapies and the recreational things that…keep him functioning. I had no clue. I went for it…And so…I can spend time doing this for him. I just felt like it was our obligation to expose her to this and to give her a chance to see what she could do.it…We’ve tried everything else…” Although Jan is not currently participating in any other formal interventions. Jim’s mother expresses similar sentiments concerning her pursuit of suitable activities: I don’t know that I really had specific expectations…at that point we didn’t have a diagnosis. And in the beginning. her parents are always on the lookout for potential activities for her. as her step-mother explains: We’re always trying to think of new things. I had no idea. so-called. and deal with problems that are ten times worse…that just doesn’t make any sense to me. Because Meghan had displayed little interest in any other activities besides her intense interest in horses. When asked about her expectations for the therapeutic riding program. for me. You do what’s better for everybody. We were still trying to figure out…what…was happening. for example.

know what to expect as far as therapies. Accordingly. Executive Director Pat explains that Program Director Denise pre-interviews each parent to determine his or her goals for the client: …and in some instances they really have no goals. you’re going to try…that you possibly can. it’s just been wonderful…when you have a child like that…you’re grasping for any and everything and if there’s…anything. what would happen. They just want their child to have some other kind of experience and…they’re looking for something else that they can do. but she is also keenly aware of how many other children with autism spectrum disorders go without any appropriate interventions: 196 . And this program…oh. it is not surprising to find that all family members interviewed for the current study are intensely dedicated to locating meaningful activities for their children. And can afford. Robin’s mother was fortunate to initially have some familiarity with existing therapies. I mean that’s the bottom line…Anything they can do…That the child wants to do so we don’t have a big fight in the car…and I think a lot of parents come to us without a goal in mind. I mean their goal for themselves is to find something else my child can do that might help in some way. When asked about her experience regarding the parents’ expectations coming into the program. Meghan’s grandmother supports her daughter’s statement: …just doing any and everything you can…We’re just trying and struggling to get her whatever it takes…to try to help her. So we were just eager to try anything. As an occupational therapist.

“…I mean we have a lot of hope for him to…fit in.…after we got the diagnosis. and must therefore establish different expectations for each. so…I want to give him an opportunity to fully explore…being an 11 year old. as his aunt explains: And he’s doing such a good job…it’s just been a wonderful thing and we hope that we can continue to do this for him…that’s how we all feel. “ …unlike Doug…he has mastered swimming…And…doing some other things. 197 . “…my goal was…to keep him…positive and…knowing… if he has to learn it a different way. and I think how many kids that are out there that aren’t getting any help or…parents are in denial or just aren’t getting a diagnosis or don’t want to deal with it… Goal is best life for child.” Brian and Doug’s mother is dealing with disparate ends of the autism spectrum with her two sons. as she describes for Brian. I started thinking about all the stuff I knew. And so of course this [CKRH] was one of them…So we were really fortunate that we had some knowledge of things that we could get him in…Of course.” John has three caregivers closely invested in his continued progress. that they’ve also tried a lot of other things. that’s common when…the parents have them in this program. family members such as Gary’s grandmother cautiously set as realistic goals as possible for their children.” With no known cure at this time for ASD. “Be all they can be. and his mom feels this way…[and] my sister. All the resources I am familiar with. we all take care of him because she’s a single parent…And…we hope that he can be all he can be and…whatever sacrifice we have to make is worth it for him… Kerry’s mother works tirelessly to find new ways for her son to grow and learn.

Instructor Mary describes this effect. Instructors.it’s no big deal. when their parents look across. because then there we both are in a mess. “I think maybe for the parents. [It]…just…takes him a little longer.. They’re just taking a riding lesson. as illustrated by Jim’s mother So many people…think. as his mother I feel like it’s my responsibility to give him the best life I can. you just do too much for him”…but the reality is. no big deal…because…of course you want to do everything you can for your own child. Benefits to parents. and I think most parents of kids with disabilities are this way… you just kind of grit your teeth and do what you have to do.. “…it normalizes something in their life……When they’re on horseback. Normalizing activity.” Rick’s mother put it even more simply. and to be able to function in life. “God gave me this one child…. and four family members spoke of the opportunity the therapeutic riding program provides for the children in the study to take part in a more typical children’s activity. “I just want my son to be happy. On the other hand…I’m not helping myself by not giving him what he needs. as her 198 . “Oh man. they’re like every other child on horseback. volunteers.” Her final interview comment came as her son approached with his horse following his riding lesson.” These parents willingly sacrifice for the sake of their children.” Meghan’s older brother was diagnosed with a condition similar to autistic disorder but was not as fortunate to find an enjoyable activity.” Volunteer Alex has noted the reaction of the children’s families. it gives them a sense that the kids are doing something normal or there’s something that normal kids do.

Like any other kid would be riding. as volunteer Jo Ann reports. So…he would do it. “…a lot of them say…[when] we first started.mother recalls. Through participation in the riding program.” Wayne’s mother compares his involvement with the riding program to opportunities available to his peers or his siblings.” and Jan’s father echoes.” Robin’s mother supports all of these observations: That’s the thing I like about this program is that these kids out there look like any other kid on a horse and so you wouldn’t know that one of them just came up on a wheelchair or…in Jack’s case…he used to be screaming and crying to get up there.” When the instructor are asked during their focus group what interactions they observe between the students and their 199 . they couldn’t really do much of anything and now look at them now…” Jan’s step-mother readily attests to this fact. It gives him a sense of accomplishment. “…my oldest child never fit in anywhere. and now there he is. See child achieve. out there riding this horse.” Robin’s mother has also seen this transformation. “…when I look…and he’s trotting and I think gosh. any of my others would do that. she would do it. parents and family members are often able to witness their children’s successes in a very challenging activity. look at his posture out there. Never achieved anything in any of the other areas because…he didn’t fit those roles…couldn’t get in the right place. “And in ten sessions…if you had told me she’d be leading a horse around on her own and mount one. “Other kids play…t-ball…and so it gives him that ability to do what a typical child does. he looks like a rider. I would have said you’re crazy. “I mean she has far surpassed…anything we thought her capable of.

. …when we first started that event. And…we’re just so grateful that 200 . I thought. “They take pictures and they smile. Night of the Stars. And…it wasn’t hard to round up the riders.and putting them on display with a disability? …that was…kind of a little red flag in the back of my mind when we started this. she’s not able. and the kids are like. she can’t do. where for some of our parents. But all those kinds of reservations really dropped after the first year because as a couple parents explained it to me…my child will never be the star in the school play. she’s not appropriate. “Oh.family members along the fence line of the riding ring.. Deb remarks.” and Mary declares. my gosh! They beam. she’s not… And then to come here and to watch their child be able to succeed…is for me…a very…awesome experience because…it’s that pride of a parent…that a lot of people see when…their son makes the touchdown or…a lot of parents see it on a regular basis. they absolutely beam. “Watch me! Watch me do this!” As the staff member who does the initial evaluation of the potential client and interview with the family members. They will never be the lone ballerina on the stage or part of any—they won’t probably even be in the chorus at school…this is a moment to shine that we would not have had. are we showcasing our students for fundraising. But of course…parents volunteer to do it. Denise is quite aware of this common occurrence: …people are telling them that he can’t do. this is…where they see it. People really wanted to do it. Executive Director Pat had some initial reservations about putting CKRH clients on stage to ride their horses in front of the attendees at the annual fundraiser. but found her concerns to be unfounded.

great job! Oh man.” while Meghan’s grandmother describes her 201 . Pride in child and limited opportunities for participation or success. During the initial parent interview.she got to be queen for the night. look over here. I mean they all went home energized and feeling so empowered by the opportunity. and go out there and applaud and be dressed and took a real sense of pride in the accomplishments. or he got to be king of the mountain…for an evening. honey! Dad: Jan. An additional option for the program’s riders is the annual Special Olympics therapeutic riding competition for which several CKRH clients are selected to compete each fall. “And it gives us a sense of pride. Jan! Mom: Look at Dad. that is too cool! I can’t wait to watch that tonight. So that reservation went out of my head…because looking at it in their light made me feel a whole lot better…Providing a moment to shine. Mom: Oooh. Achievement typically elicits a sense of pride in parents resulting from their children’s accomplishments. the researcher was fortunate to witness firsthand the thrill Jan’s parents experienced when they paused to videotape her triumphant attempt to mount and sit astride a horse for the very first time: Mom: Way to go Jan! Dad: Jan! Jan!! Mom: Way to go! Dad: Jan! Jan. and her mother reveals. Because…competing in things that…we didn’t think would be possible. Meghan will be riding in the Special Olympics this year. Nobody went home terrorized. that was a huge step…Only the beginning.

as volunteer Shirley notes. makes parents happy.granddaughter’s excited anticipation and the effect on the extended family.” Such visible reactions of the parents have a positive effect on 202 . As the competition draws near. So this is a big deal…And it’s their moment…for their child to shine and they want them to look great. many concerning appropriate riding attire for the event: …we probably got a gazillion phone calls a day over people’s stress. “…you can look over there for one hour and see the parents grinning from ear to ear and watching their kid ride.” Just prior to his interview with the research. He later discussed the process of preparing for this new challenge: …I think they’ve [CKRH staff]worked with me very well with trying to help me to help him achieve the goal of the Special Olympics and I’m so grateful for that…and he’s done remarkable and I think…he’s going to be a shining example for CKRH and I’m very proud of him. Rick’s father was told his son had been selected to compete. and immediately made a cell phone call to his wife to share the good news. Executive Director Pat fields multiple calls from excited parents of the competitors. I believe…she rode the first time when she was seven she won a sliver…So we were so pleased. CKRH staff and volunteers are quite often placed in a convenient position to observe positive reactions from the client’s supporters. Because this is the big day in the life of their child…I can think of two of those riders that know how many days it is until next year’s Special Olympics. I mean…[they] kind of…count it down. Gratifying. He was obviously thrilled with the news. “…and the family is coming from all over and…this is her third year.

” Serving as both the program director and an instructor. deeply grateful for everything that everybody in the program does and…if it wasn’t good.” Jerry’s mother wholeheartedly agrees: I would recommend it to anybody…obviously I would recommend it to any parent with a child with autism…because I have seen results from my child and I see my child so happy every time we show up here. it’s just a joy because you can see parents with grins from ear to ear and kids getting off and they’re tired but they’ve done this thing…” Volunteer Jo Ann has taken the opportunity to interact with parents sitting on the sidelines during the lesson times. I think. I mean.volunteer Sherry . volunteer Perry doesn’t have as much direct contact with family members. “Wow. She readily appreciates their interaction with each other. and the excitement just in his 203 .” As a horse leader during the lessons. “Yeah. more than happy that their kids are making progress. and I will continue to in the future because…I think it’s been a blessing and a Godsend for us to have been in this program.” John’s aunt supports the therapeutic riding program by making copies of CKRH information to distribute to parents of potential clients. “I would recommend it to anybody…And I have. “I mean if you just sat down on the picnic tables…during. Denise probably deals the most actively with the greatest number of parents and family members. my child can do this. “…and then the next thing that I see—I don’t know how many actually identify it—but that I see is just the satisfaction and the pride and the amazement that. but when he has talked with them. he reports similar responses. before or after whatever sessions. they’re all happy to be here. I have yet to hear a parent who is not happy that their kids are here. “…all of them are just deeply. you can talk to anybody about anything. they wouldn’t keep coming back and they wouldn’t be so grateful.

but to have it as a group. “…Alan…expects a lot and is very to the point and that’s what Steve needs. and…it was great. John’s aunt credits a specific instructor for her nephew’s progress. He thrives off of people who are very disciplined and Alan is a very disciplined teacher…so he does real well with that type of 204 . knowledgeable. “Oh. she’ll like this. Caregivers feel comfortable leaving their children under the supervision of patient. “…Suzanne worked with him for like a year and a half and.little body. to get therapy on top of it is so exciting. and have him love something so much. Qualities that the CKRH staff and volunteers possess that are reassuring to family members were first recorded during the instructor focus group when Mary recalled a conversation with Jan’s stepmother: …but her mom would say to me…“You’re so…patient with her. And I got the very distinct impression from her mother that there were a lot of people that rushed her…that didn’t take time to let her process and sequence all of her events…just kind of. she’ll go here”…and I think all of that’s one thing we all have in common here. Supportive environment. well. They have such patience with them and…they’ve seen the changes in them too. and capable instructors and volunteers.” as does Steve’s mother.” and kind of just thought for her – “O. I would still be just as ecstatic.” Because she [Jan]…does a lot of repetition – “Are we done? Are we done? When are we gonna be done? Are we done? Are we done?” And I’ll say “Nope – we’ve still got work to do!” And off we go. she’ll do this.K. following her son’s move to Alan’s class for more independent riders. even if he was only coming to ride a horse and not getting the therapy.

even when he gets explosive…they all handle it very appropriately and nobody gets frustrated with the fact that…they’ve just been socked in the head again…So that means a lot…that patience. He’s not the only child. “…in an environment that’s welcoming and accepting and uses her potential and accepts her limitations…” Jerry’s mother appreciates being able to take advantage of this reputable. And…it’s actually a really. and I think he sees. high quality local intervention: …I think this is incredible. I’m very. Doug and Brian’s mother also provides an enlightening insight into the trials faced by a parent of sons who represent visibly different points of the autism spectrum: …and it’s done in an environment…just the nurturing nature of…the folks that are in place out here is…something that…I really cherish because…when you 205 . he is not the only child we’ve ever seen do this. Bob’s mother is particularly indebted to the competent efforts of the staff: Well…Denise kept saying. Meghan’s mother recognizes the combined effect of all the CKRH personnel that allows her daughter to excel. they’re not going to hold that against me…” While praising the efforts of the CKRH program. I promise you…Everybody that we’ve ever seen work with him. very excited that people are out there and…we have been extremely blessed to be in Kentucky…where we can have these alternative therapies…I have friends with children with autism and they aren’t so fortunate. really exciting and rewarding thing.K.. “O. As the parent of a child with physical aggression issues.structure. and it’s great that there are so many people out there trying to help our children.

” Jim’s mother thinks of it as an even exchange: …my mother keeps saying. One unintended benefit of the therapeutic riding lesson. as a class volunteer. I mean. as volunteer Shirley points out. And…you run around to different things and you’re…trying to keep your kids…mainstreamed.have a child with a special need and a special challenge…and in Brian’s case it’s not quite as obvious. So then you kind of become a little more protective of…the challenges that he does have and…the folks here are just so adept at…truly trying to measure each child. Not the case. as Rick’s father notes when discussing whether or not other CKRH parents volunteer in the program. “…. trying to keep him out doing things. “…you get a sense of…giving something back…I think you do give a break to the parents. with Brian. as he does.some [parents] just look so tired and…this ends up being a break for them…I really can’t criticize them for that. so much.” I said.” The seemingly simple pleasure of a respite from a child who often requires a large investment of personal energy is a significant feature for many parents. is that “…it also gives the parents a break. he can help make this happen. quite frankly. “You just run yourself ragged. “Well…if I’m running myself ragged to keep him out doing 206 . you can meet my son Doug and immediately recognize that he’s a special needs child. and how can we help…[each one] along…You know…it’s really hard…to live in an atypical world. And…it’s just kind of like a big sigh of relief…You walk out here and you don’t have to worry about if your kid’s doing something strange or…I mean I feel like…you know you’re welcomed here.” Alex appreciates that.

I couldn’t put my finger on one thing other than saying. as she enjoys sharing this down time with other CKRH parents: Well that’s what we were saying a few weeks ago…two of the other moms and I were sitting and just chatting and…this is just as much for us. but the overall process tends to affect family members in a positive manner as well. I feel 207 . Executive Director Pat has heard a similar refrain from many parents: And then sometimes it’s just the frustration… “I’ve had such a frustrating day. you have no idea”… “It’s just been one temper tantrum after the other and”…“We just need to come out here.things…while he’s out here I can sit and read a book or do whatever…I can be outside. it is therapeutic in all areas…and it’s not just for the child. and everybody’s happy”… The therapeutic riding program intends to primarily target the needs of each client.” Wayne’s mother concurs. as it is for the kids because we get adult time when we can sit and swap stories or just talk and just have – oh my gosh. I can relax. it’s the family…” Doug and Brian’s mother made a more direct link to the facility: …you just kind of feel like it’s family and you really enjoy that…and the folks that administer it is just their openness and willingness…it’s a partnership. I think. It’s the parents. I can do some things. get a break. … “And as far as how does it help. And just talk…it’s nice to be able to sit down and…relax and not have to worry about him taking off. I don’t have to worry about what’s going on with my child…my special need child and…so it’s just nice to be able to sit for an hour. sit outside. as denoted by Meghan’s mother in assessing the benefits of the program.

also taking into account input from the child’s physician and any therapists involved in his or her overall treatment. If that’s not possible due to weather or other conditions then we may start on our Equicizer [mechanical exercise horse]. And a parent and/or caregiver comes out to CKRH with the participant and…we ask the parent to go through a written assessment just to kind of give us some feedback of where we are. I’ve got people who understand… From the initial application and evaluation process. whether it’s on the Equicizer or on the horse. there’s no reason why this individual could not participate or should not participate in equine assisted activities…Once that is signed and turned in to us…then we schedule an assessment—a time to meet. And we will either plan…an activity that is non-mounted with a mini [miniature horse]. but…what we’re trying to do is get an assessment of…do we know left [and] right. the therapeutic riding program is designed to be a joint effort among the CKRH facility and the client and family members. I’ve got friends. just me as a parent…I’ve got partners.like I have partners. what are our fear levels…we’re getting a base of where we’re going to start 208 . Program Director Denise describes the intake procedure: There’s registration…that they must complete…And a medical history must be obtained and a physician’s signature…that just basically says…in my professional medical opinion. I feel like when I come out here. what is our sitting balance astride. or…if the individual—we feel reasonably sure—is coming into us at a level where they’re ready to get on the horse. then we will…include a mounted assessment. I’ve got support system. do we know our colors.

the school teachers.. So if we’re running into behavioral issues…then we develop a behavioral plan in that assessment time or at the beginning of the year.. with appropriate client information made available to class instructors and volunteers.from. but all pertinent information. find their rider and go. the Rider-at-a-Glance cards are a fairly recent addition that allow any CKRH volunteers to review the behavioral plans that have been designed for each client. the PT.. objectives.” So this is developed by the parents. goals. Not medical information. We have what’s called a Rider-at-a-Glance card so that at the beginning of each year…either myself or the full time instructor writes out an individual’s goals and all pertinent information. the participants have access to those cards. those type things. the other professionals that are 209 . where are we now?”. The dynamic process continues through each riding session. “O.K. “O.. this is what I should do.. And volunteers. parents have access to those cards.What are the skills that we’re going to be working on so that we can fit them in the best possible lesson to work on those goals…Every year…we come back and say. the OT.The assessments are normally done with myself and the full time instructor…we feel like that that is key for them to develop lessons. as Denise describes: And we work through a plan of action…with the parent.K. medical history and assessment details.. Although the staff members and instructors have access to the complete client files containing each client’s diagnosis. or whenever appropriate…and that’s documented on that card and it’s set out with the volunteer registration on each lesson so that a volunteer can come flip through. this is the behavioral plan.

then we have no behavioral issues…if you are asking him to get water before he goes to the bathroom. And if you follow that every time. you’re going to 210 . there’s a behavioral plan for that. You immediately get off the horse. You get the helmet. And this is the routine. Thrown across the ring…well hopefully you can catch it when the hand’s coming up here. Well. you redirect. One CKRH client in particular epitomizes the classic need of a child with ASD for a standard routine. And their daily living world… Denise describes the utilization of a management strategy for helmet compliance that follows the behavioral plan described on his Rider-at-a-Glance card: …an individual who rides with us…five minutes in. So we’re following the same plan that everyone else is in their therapeutic world. But that doesn’t mean it’s the end of the lesson. toss that helmet.working with this individual. you get back on the horse with the helmet and…you keep going Doug’s screaming outbursts have also been successfully managed through the use of his behavioral plan that models the same approach used by his mother and his teachers. you’re going to have a behavioral issue…if you’re asking him to get on the horse before he gets his water. So every volunteer that—even if they’re subbing for that day—they can read that and they know…these are the steps and this is the process that Rick needs to go through…before we get on the horse. but sometimes it’s very fast gone. and any unwitting deviation from this schedule on the part of the staff or volunteers can lead to adverse consequences. It’s gone. as detailed by Denise: Another…example in terms of behavioral plan…is Rick…we have a very consistent routine and that is documented on the…Rider-at-a-Glance.

have a behavioral issue. which is so crucial to a positive ongoing therapeutic relationship: And so then it would be up to us to sort of sit down and say. We talk about it with horses and we talk about it with our clients as well. in your lesson and…you might wanna do this at home…or a suggestion that could be implicated…at home”…I mean I think a lot of our instructors have very good rapport with the parents of their children and they can say…“This [client] is having a bad day today. instructors. and also welcomed the appearance of the Rider-at-a-Glance card system: Shirley: …One of the things I like about some of the parents through the years…they’ve been forthcoming telling us how to communicate with them…or 211 .” and they figured that out. volunteers and caregivers throughout each riding session. something was a little off. “How about we work on these things or work on these things. So we lay out the plan and you have no behavioral issue…Prevention! And you know we talk about prevention a lot here. It really is all about the prevention…Sometimes a little bit of prevention…you don’t ever have to do the problem solving because they don’t occur. I wonder what the difference was. and…this is what we worked on today. like what it could be or…“Today was just so great.” and…maybe it’s something as basic as a nap time…that didn’t happen or could happen and maybe it’s because we switched horses…but those things are sort of…a good conversation between the parents or the therapist and…the CKRH instructors. Executive Director Pat illustrates the communication that takes place among the staff. which is really nice. Members of the first volunteer focus group have often profited from parent or caregiver suggestions.

as noted during the second volunteer focus group: Perry. which is really helpful. they started those cards this year that supposedly have all that stuff on them. Sherry: Yeah. so just say no. Such a teamwork approach between riding facility and caregivers cannot help but provide insight into the atypical lives of the clients’ families. effort. he’s going to push you as far as he can.”…or just little things… Sherry: Yeah. Jo Ann: It takes a special person to be able to put time. “You’ve got to be tough with him.even if it’s sign language or if it’s…”This is what he’ll respond to better. Alex: Well. yeah.: I think the parents of these children are special as well…and…I don’t know what goes on at their homes…but just to see them…I think the parents of these children are really special as well. as well as the development of respect. how to hold them. I mean they have to be.”…[that] kind of thing… Shirley: And then there’s also the thing where…some of them don’t like to be just barely touched… Sherry: Touched.”…and that’s real helpful if you can talk to the parents…A parent will think of something…and say…“Well he really likes to wear gloves when he rides…so I’ll bring. as Meghan’s mother 212 . Shirley: …if you’re going to have contact. I know what you’re saying. Family members feel a sense of alliance not only with the CKRH staff and volunteers. and…keep a level head and still enjoy their lives. but also with the parents of other clients in the program.

And sharing resources and just conversation and support and so that’s a big thing. Executive Director Pat feels the majority of such unstructured group meetings take place at the old picnic table located outside the barn and adjacent to the riding rings: Well…it’s not a direct service that we provide. “It’s therapy for everybody…There’s a lot of networking that goes on…In that hour of time where your kid’s on the horse and you’re sitting there…I have gotten so much information. So much. but chances are there are so many variances that…it’s like. “…you find out a lot of interesting stuff and what works. it’s just one of those little things. “O. being able to spend the hour when their child is riding.” but then you can give them ideas that you’ve done and vice versa… Staff members are especially cognizant of the existence of the facility’s informal family support network. Everybody’s diagnosis is different.K. and even if there’s two autistic kids. what doesn’t work…” Wayne’s mother also speaks to the advantages of trading information with others in similar situations: …[Be able to] Talk to another adult that knows at least somewhat of…what you’re in…I mean everybody’s different. as described by Program Director Denise when asked how families benefit from the program: One is the social interaction and the networking.. they are guaranteed to be different…You might have some similarities. we don’t have that problem. Our old picnic table outside…we’ve always said is going to go with us when we move to the new facility because a lot of things happen at the picnic table. yeah.explains. dedicated to talking to other parents that are in a similar situation as they are.” Kerry’s mother concurs. The networking is a big thing…for parents. 213 .

So as parents are watching the lessons and they’re sitting there week after week together.: Well that’s support for each other. Shirley: And a lot of these parents…the kids. Shirley: Well it is. And as long as they can see what the other people [go through]… Alex. Volunteers in the first focus group are also quite familiar with the significance of the picnic table for the parents and caregivers: Sherry: The famous picnic table. but they also swim together or they bowl together or…they go to the Parks and Rec’s dances together and stuff like that. I’ve tried this. if you’re going to that school. but it’s a resource…I think a lot of the best stuff is at the picnic table. this is really good. they’re out here riding together. you better watch out for this teacher because she doesn’t know anything about autistic students”…it’s everything from soup to nuts.Because the children tend to be roughly the same age…they roughly have the same challenge and are working toward the same type things. they start to really share…resources. like you said. it is…They’ve gotta have support for each other…to put up with…it’s hard.” or “You know. So they have other interaction with each other. Shirley: …But if they’re talking to. “Oh. I mean…when you talk to the parents at the regular school…they’re not going to have the same understanding. 214 . They can understand where they’re coming from. a lot of them. a parent of a normal person then it probably would make them feel worse about their…make them… Sherry: A little defensive or a little uncomfortable.

Jerry’s mother describes the effect of his seemingly simple victory in sufficiently overcoming his sensory issues so that the family can have a puppy. As Steve’s mother observes. This is a great program and limited funds and they need all the volunteers that they get so…I just said. “That actually happened!…I did tell my friend who has a child with 215 . “Hey…I’ll do it”…some parents do. some parents don’t…I’m tickled just to be able to give back and come up with something that might help other kids. Services provided can become reciprocal when parents and family members of clients offer to volunteer at the therapeutic riding program. Wayne’s mother quickly responds.” Rick’s father has been an enthusiastic supporter for several years and feels he can contribute suggestions for strategies that have been successful with his son: …I’ve not only been a parent and a client but I’ve also been a sidewalker…and I intentionally…offer because I felt like…I should always give back here. Actually…I kind of enjoy it… I come out Thursday afternoon and sidewalk…it’s rewarding to me to be able to help kids like Jacob. “And it’s actually something very simple to most people. but to us. “…volunteers are so important to the success of the program…so I don’t mind helping. it is a huge milestone.Parents give back as volunteers. Program exceeded expectations. Parents and caregivers of 11 of the 15 children in the study feel their child’s experience in the therapeutic riding program has exceeded early or initial expectations and readily recommend the program for other children.” When asked if they would recommend the program to other caregivers dealing with autism spectrum disorders.

you know…Kerry’s little buddy. I tried to take her by the Horse Park but…[when] she thinks Riding for 216 . If they had sessions all year. I was a little skeptical.”…I just tell them…how I’ve seen the biggest improvements here and even after all these years of therapeutic interventions.” Meghan’s mother has seen “…improvement in all areas. that they’re finding it can…But it’s definitely helped…it’s helped more than I ever thought it would…It’s just amazing.” and Meghan’s grandmother wholeheartedly agrees. You just can’t imagine what it’s going to do for these children. you need to get in contact with these people. You’ve got to get out there. we would be there every week. it’s his best friend in the whole wide world and…his mom took him out of our school and put him into a Montessori school. “…I have already recommended this program many a time… ‘Listen.autism. and that’s what is so amazing.” Robin’s mother concurs. of course. it’s been a great experience for him. And I tried to get her into this group. “And I just didn’t dream of all the things that would improve. “You have got to get your child in this program. Yeah. She’s just not buying it.’” Kerry’s mother acknowledges that some parents are unaware that children with ASD can indeed profit from the therapeutic riding program: Because it used to be thought…[that it was] definitely physical disabilities…That has been a huge…but then they didn’t think it could help…just children with other issues. and…he’s actually riding here now…but why I would tell them…it’s just. If we could do it every week. we would be there every week. which he’s doing really well…But…He says he doesn’t have any friends. after we came here…I spend a lot of time telling people.

and even the ones who haven’t asked me. went in a paddock or two…and Denise said. I’m like. she thinks of children in wheelchairs and things. “Well we’re not going to do it anymore.” And…it’s just wonderful.” And she was here just a short amount of time. They’re all like him.Hope. And as long as it’s helping him…And the psychology department at EKU waiting room and the waiting room at the EKU speech… people will ask me what kind of therapies…is he in. there’s not one. “Oh. I’ve had people ask me since we’ve started coming here. followed Denise around. They’re all like him. I’ve had kids that have had a lot harder time than this on an evaluation visit”…but…watching how they’ve started at the very beginning…and then just slowly moved along… John’s aunt was also more impressed after the first few lessons: When we first brought him…I thought. I recommend it to them…I would like to do this for as long as he tolerates…he wants it. Because…when I saw how…tense he was and unsure he was of the horses. And I will tell 217 . yeah. such as Jan’s father: One of the volunteers…mentioned it to my wife and I talked to Denise on the phone and…I really didn’t know what to expect. this is not going to work. let me spend some time with her…I’ve been doing this long enough to know whether I think…it’s something that we could do or not.” Some parents admitted to having initial reservations about the willingness of their child to participate. So I’m so glad that I didn’t just…stop and say. but she said…“Bring her out.as a matter of fact. “Look [at Kerry’s]…class. and I would have never ever thought that he would have…gotten to the point that he is now. I would recommend it to anyone….

I said “Well. and then I will bring up the horse therapy…And I tell them that…I really think that the child would benefit from that… Bob’s CKRH initial evaluation undoubtedly remains one of the more memorable in the staff’s estimation. And so I knew Bob’s temperament. It was a matter of we were just going to see what happened. we were looking both at music therapy and the riding. And. I’m uneasy on a horse. thanks to his aggressive reactions that involved physical attacks with his fists. 218 .Well. They weren’t real sure. thank God…it really was a positive experience in a way that’s kind of hard to describe. It’s been a very positive experience for him…for all of us. It’s been a very positive experience for him…for all of us…initially we thought it was going to be the worst experience in the world…because…the evaluation was horrible…at that point in time. I’ll try one session of riding. His mother has therefore been pleasantly surprised with the eventual outcome: …we didn’t have a whole lot of expectations.. And …nobody else had responded…And my comment back was that we really enjoy it. it’s the fight or flight takes place…and the nice thing was. Socie’s a nice.. they just knew it was out at the Horse Park and didn’t know much about it. that when he gets uneasy. so in fact I told my husband. but I’m not expecting to stick it out”…I mean. even-keeled horse. somebody mentioned the riding.them. And…we’ve seen some really good things come out of it…and…we really enjoy it. Her faith in the program extends to a willingness to readily recommend it to others: The autism group had an email shooting out and somebody said what therapies are there out there?.

In particular. but…progress was made. Denise provides details on both the typical parental reaction and also on the gradual desensitization approach that has provided for many successes. even as just the executive director of this program…I would start off by telling them chances are we can help in some way…I cannot think of one of our autistic patients that hasn’t achieved some benefit from this. especially with the initially-reluctant client: A lot of what I hear is a surprise. You just don’t understand…I don’t even know that I can get him or her there and what is your process”…and I said.Executive Director Pat is regularly called upon to advocate the CKRH program to potential applicants: Well. I think. some may have been lower than others. I would feel very comfortable telling that to a new parent coming into the program. That just cried and cried and cried and then went home. I cannot think of…one student that had a horrible outcome or a non-successful outcome. And we spent…three weeks 219 . find out how accepting the individual is of all of the sensory input and then we will work our way from there…and there has been multiple occasions where we started with just walking the center. “I was told that I should try this. speaking directly to individuals who are…on the more severe end of the autism spectrum.behavioral issues. the pinching…those types…The high level of fear…and a lot of them call over the telephone and say.. let’s try…We will start with what we have and we will start out walking around. “Come. but I just don’t know.. the hitting. As Program Director. (Laughter). Now…the attainment of goals for each individual. So maybe they’re nonverbal.

walking. But when that child is able to sit on the potty it’s a life change for the families. Most often. nowhere near the horse.. Toilet training.. Every week we would come in and for 30 minutes we would just walk the center…The center being CKRH…We weren’t anywhere near a horse…we just started out walking through the barn and so we smelled smells and we had sights and we just processed that…and then we…we would walk by the pastures. the families ever really thought that these individuals would be riding a horse. and in those cases in particular. which may certainly be considered a benefit to caregivers as well. as Executive Director Pat as articulates.just learning to sit up and ride the horse is so huge. what I see is just total surprise and amazement [from the caregivers]…for your study that would be…Jan and John…. “. And then each week we would get closer and closer to a natural horse until we were…introduced…and then the next six weeks we spent…only working around the horse because we weren’t getting on…and then eventually…we moved towards getting on the horse and…so that was the plan. Benefits to family. And I think it is—it was just total surprise and amazement and disbelief really…I don’t think…in either case..that we worked through that plan with.” 220 . but so that we could see a horse. three parents credited the therapeutic riding program with their children’s progress in toilet training. As discussed in physical benefits.

providing an outlet to the horse-crazy sister as they assist in the barn with horse care and lesson 221 . Doug and Brian’s mother is grateful for the opportunity for multiple sibling involvement: And I…really enjoy the fact that…the boys can do something together. And so that’s a good quiet…break. highlights of the year is the…Christmas party that they have. as his grandfather notes. they provide encouragement and support. Gary’s grandparents regularly transport him to his lessons. and although they are not familiar with horses themselves.” Executive Director Pat is aware of multiple family members simultaneously enjoying the lesson time while at the Kentucky Horse Park. Positive effects of the therapeutic riding program sometimes extend in a more direct way to family members other than the child who is participating riding.. As the parent of two program participants.Activity family can do together.we’re his cheering section. where the riding facility is located: And we have had comments from parents where if the husband and wife are both here with the siblings…maybe the wife stays [at CKRH] and the hubby takes the two kids down into the Horse Park and gets them one-on-one time without the child who gets most of the attention because of the needs. “We’re not professionals in this. so the siblings are down in the park and spending some good time on the playground or looking at horses with dad. even though they’re not in the same class…I enjoy that and…it gives them a little bit of a bond together and…so it’s been a great experience…I’m a single parent and…one of the kids’ and my daughter’s as well.. Both Steve’s mother and sister have become CKRH volunteers.

“I am becoming a horse person…my daughter loves horses and…always has and so she was excited to get to come help…Since she didn’t get to ride…she’s got her own thing.preparation. Maintaining balance with appropriate attention and activities fairly distributed among siblings can be a challenge for any family. with which Meghan can readily identify. And…I saw that they had CKRH…And this was something I’ve always wanted to do with Wayne because…I’m a horse person…I just thought it would be fun…and maybe it would be really good for him because I’ve seen how it…and heard how it’s helped… Sibling issues. “Ooh–I get to take riding lessons. she thinks that’s perfect and…the sun was in her eyes and I had an old Horse Park cap there in the car and I got it and put it on her and she just thought that was really special. including Bob’s mother.” Five parents referenced comparisons among their children. as his mother laughingly relates.” with Alan supplying the logical completion to that line. She gets to groom the horses and…she loves it…” Meghan’s grandmother describes her work as a volunteer for the Kentucky Horse Park.” As a horse lover. “[Bob] knows his brother plays sports…So…this 222 . child has own activity. caring for horses in one of the barns and interacting with Park visitors. The topic of sibling rivalry was first raised during the instructor focus group when Mary reported the pride of one sibling saying. Wayne’s mother had been eager to have her son try therapeutic riding even before their move to Kentucky: We’d just moved down here in the summer of ’06. “Oh yes. but even more so within a home that contains a child with special needs. “I can ride better than my brothers and sisters.

Robin’s mother has dealt with the same problem in a slightly different manner: His sister usually comes with me and…it just kills her to watch him on this horse because she wants to do it too. So…this is his thing and he’s proud of it. He’s not afraid. “…this gives her something. She’s got ballet and gymnastics and I’m always saying. like he used to…but this he knows he does well. too…her brother is real good in sports and all this stuff. of course his little brother is in the same class…and he’s…doing it all over the place. But…[Kerry] doesn’t get frustrated anymore. 223 . Summary The current study elicited a wide variety of data related to perceived benefits of a therapeutic riding program for children diagnosed with autism spectrum disorders. He might be younger but he’s really good in all that…so this gives her something too…” Kerry has been taking gymnastics lessons for over three years. but his younger brother shows greater prowess in that activity. “Sharon.” Steve’s mother has attempted to provide equilibrium between brother and sister: …his sister…actually works in a barn here on Wednesday nights…she’s involved in a lot of stuff outside and has been pretty successful at things that she’s done and…since Steve doesn’t do anything…he feels like he doesn’t get the same amount of praise as what his sister does.” Meghan’s grandmother echoes this sentiment. “And.” And he just saddles up. His mother feels Kerry’s success in therapeutic riding helps him cope with this disparity.is his thing…this is Bob’s. this is something that’s special he gets to do. And it’s the one thing we keep special for him. And she’s tried to get on a horse before and was scared to death.

which in turn augmented skills in following multistep directions. and the calming effect of therapeutic 224 . Class exercises and activities led to improved thought processing and subsequent gains in overlapping physical skills such as spatial awareness and motor planning. Repeated exposure to the novel sensory stimuli associated with the CKRH facility triggered new coping mechanisms for both hypo and hyper-sensitive clients. communication and the opportunity to practice appropriate social behaviors are among the most noteworthy triumphs for individuals who display the classic social deficits of autism spectrum disorders. which in turn promotes a greater feeling of acceptance and an appreciation of how one’s actions affect the behavior of another being. learning to deal with changes in routine. Increased interaction. Modification of inappropriate behaviors. Reported outcomes of particular significance to this population include decreased self-stimulating behaviors and progress in toilet training. strength and endurance is important for children with ASD who may be precluded from other sporting pursuits by their hallmark social limitations. the movement of the horse. and increased motivation were credited with many gains including expanded vocabulary and use of language. Deep pressure input. Many caregivers noted decreased apprehension and enhanced physical prowess that carried over into other activities of daily life. The indefinable quality the horse contributes to the intervention provides a catalyst to help bridge the gap in human relationships. The opportunity to participate and become proficient in a non-competitive physical activity such as horseback riding while improving acuity in gross and fine motor skills. Children in the therapeutic riding program are more motivated to form bonds with both humans and horses.Reported gains in cognitive processing included an increased ability to maintain focus and attention during riding lessons.

the qualitative methodology produced a unique glimpse into the personal journeys of the family members of children diagnosed with ASD. All family members interviewed emphasized the importance of their children having an enjoyable activity that is theirs to look forward to that brings happiness to the child. confidence. and a sense of internal locus of control gained through achievement in a challenging activity enhance self-concept in children who often have limited avenues for success. The normalizing experience of therapeutic riding affords them an uncommon opportunity to take pride in the accomplishments of their children and provides a welcome respite from their daily struggles in the less-hospitable outside world.riding are extremely valuable outcomes for children with ASD who experience frequent temper tantrums or meltdowns. Pride. Finally. Copyright © Margaret Ann Stickney 2010 225 . Always seeking effective treatments for their children--often armed with limited knowledge or professional guidance--family members find comfort and support in a welcoming environment that understands the unique challenges of their children.

and Recommendations The purpose of this study was to examine the perceived cognitive. and instructor lesson plans and evaluations were also reviewed by the researcher. Three focus groups and two personal interviews were conducted with riding instructors.Chapter Five Summary. this chapter presents the conclusions of the study followed by a discussion of the findings and recommendations for implementation and further research. This chapter is organized according to the recommendations of Cottrell and McKenzie (2005). rather than what could be captured with standardized instruments. The chapter initially presents a summary of the results of this study presented in Chapter Four. and social health of this population. The research design utilized multiple methods to gain an in-depth perspective of the program’s effects on subjects presenting primarily with ASD. initial client evaluation forms. social. 226 . Kentucky. The qualitative methodology provided the researcher with a greater understanding of the particular experiences of the intervention that could potentially help maximize the physical. located at the Kentucky Horse Park in Lexington. Conclusions. physical. Records such as client registration forms containing medical information. class volunteers and staff members of the therapeutic riding program at Central Kentucky Riding for Hope (CKRH). Following the summary. Discussion. emotional. Semi-structured interviews were also conducted until saturation was reached with 22 parents or related caregivers of 15 children diagnosed with autism spectrum disorders who were enrolled in classes at CKRH in the eight-week fall session of 2008. and psychological benefits of a therapeutic riding program intervention for children with autism spectrum disorders.

however. and participation in life activities are relevant to all persons with disabilities. Healthy People 2010 illustrates the particular importance of providing appropriate health promotion and prevention of secondary conditions for this age group. but persons with disabilities share many of the same challenges to optimal health and wellness. The federal mandate of Healthy People 2010 (United States Department of Health and Human Services. with the ultimate objective of achieving and sustaining a level of physical and mental wellness that encourages a fullness of life. Many interventions that target optimal health. there is no cure and no single accepted treatment for ASD (National Institute of Health. including Disability and Secondary Conditions. but increasing numbers of riding centers devoted to the therapeutic value of this 227 .Summary The impact of disability affects individuals in a variety of ways. well-being. At this time. 2010). social. Horseback riding is considered by many to be merely a recreational or sporting activity. Emotional distress caused by environmental barriers that limit the child’s ability to participate in life activities can contribute to a decline in both physical and mental health. and affected children have both increased health concerns and a susceptibility to develop secondary conditions. 2010) encourages efforts to increase quality and years of healthy life and to eliminate health disparities among different segments of the population. This combination of factors necessitates a continuous need for appropriate programs within a community that can help maximize these children’s overall physical. Noting an increase in disability rates among youth. and social health status. emotional.

activity speak to the long held belief that greater benefits may be reaped from the almost mystical attraction horses have always held for man. Equine therapy programs accredited by the North American Riding for the Handicapped Association (NARHA) provide services to over 42. Washington. in contrast. There have been few peer-reviewed studies on the effects of therapeutic riding for ASD. although even small improvements that traditional measurement tools might not be sensitive enough to detect can have major practical and psychological significance for participants and their families.000 persons with a wide variety of disabilities. Therapeutic riding. Small sample size and heterogeneity due to variances in age. Proponents of therapeutic riding are quick to provide lists of potential benefits for persons with a range of disabilities. The horse serves only as a treatment tool in hippotherapy (Hamill.. Hamill et al. and severity level of symptoms among subjects have often limited consistent demonstration of positive effects. with the long term goal of independent riding if possible (Haehl. sex. Psychosocial benefits derived from therapeutic riding have received little focus within any population. 2010). which is reportedly becoming one of the largest populations served in riding programs. but research support for these claims over the past two decades has remained scarce and is primarily limited to studies of physical benefits for riders with cerebral palsy. which is considered a medical intervention and must be provided by a physician or a licensed physical or occupational therapist. There are two types of equine therapy involving mounted work: hippotherapy and therapeutic riding. 228 . & White. 2007). Giuliani. & Lewis. 2007). 1999. requires the rider to learn the basics of guiding and controlling his or her mount. including ASD (NARHA.

2000). such as the ability to follow 2-step directions or language skills.. 2000). this study reported many references to perceived cognitive benefits. 2009).Conclusions Cognitive benefits. language development and the ability to make decisions and solve problems (Edelman & Mandle. As one mother describes. 2002).or hypersensitivity to sensory stimuli. Appropriate therapeutic interventions for children with autism spectrum disorders therefore often target appropriate sensory and motor stimulation as well as cognitive skill development (American Psychiatric Association. Individuals may display either hypo. Cognitive abilities include skills such as focus. Cognitive development and learning ability can be augmented by sensory and motor stimulation as well as proper nutrition (Murray et al. attention to task. 2003). comprehension. While the literature regarding cognitive gains from equine therapies mentions language skills only. while performing poorly in others (American Psychiatric Association. Nearly all parents or caregivers noted the opportunities provided by the therapeutic riding class lessons that incorporate exercises and tasks requiring cognitive effort into the main riding skill drills.” 229 . notably regarding the use of language. Increased processing opportunities. With information from medical histories. “…this program…gives him an opportunity to try to apply some things that he’s working on very specifically in speech and in OT and in PT and it just kind of pulls that all together. Children with ASD often exhibit high levels of capability in certain areas of intellectual functioning (Sadock & Sadock. lesson plans are designed to focus on each individual’s targeted needs.

Wearing a helmet is a requirement for class as well as a particular challenge for riders with ASD. instructors must sometimes employ a gradual desensitization approach when introducing the client to the facility and the horses. so instructors regularly find creative solutions to handle helmet refusal. Novel sights. and smells as well as the many tactile sensations presented by the riding equipment. One girl was initially overwhelmed with the sensory experience. she wanted no part of that. grooming tools. Small introductory steps typically led to surprising accomplishments. “…she could not come in the end of the barn…she was terrified of animals. that just overloaded her. as expressed by one 230 . While some clients have unusually high thresholds of pain that could put them at risk for injury. it is more common for clients with autism to become over-stimulated. perhaps only walking the grounds while gradually moving closer to the horses over time. sounds.Instructors and class volunteers readily recognized improvement over time in their clients’ abilities to follow directions from the instructor and perform sequential tasks such as picking up a ring from a bucket on one barrel and successfully maneuvering their horse to another barrel where they place the ring over a traffic cone. any type of animal. often resulting in emotional outbursts or tantrums. and the horse’s coat and movement were considered a particular advantage for the children. lesson props. such as sending a helmet home to allow the client to practice wearing it. the whinnying and…the activity of the barn.” Accordingly. Sensory input. The sounds. The fact that the therapeutic riding facility provides a wealth of unique sensory stimulation for its clients was stated as a consideration for choosing this program by several parents.

you might get your foot stepped on or your might get…knocked by the head or something…” One mother credits therapeutic riding with her son’s becoming more 231 . CKRH staff.” Proprioception. Executive Director Pat pointed out a most practical incentive for clients to develop a sense of personal body placement when working around horses. well that started with…we didn’t know if she’d ever even put the helmet on. or knowing where one’s body is in space. Proprioception. “…and then this…victory today of actually getting on a live animal.” Motor planning. instructors and volunteers shared examples of cognitive processing related to motor planning skills in which the clients learned to execute the correct sequence of movements in order to accomplish a requested task in both non-mounted activities such as grooming the horses or maneuvering their mounts through a variety of class exercises. One father has observed his son’s progress from needing verbal directional signals in order to guide his horse in the ring to being able to mentally plot what he needs to do to control and direct his horse to accomplish the overall task the instructor has requested.father. The client’s ability to maintain proper alignment of the body while riding a horse is a learned skill that is crucial to remaining safely atop the animal as it moves. serves as a foundation for development of the balance and coordination required for movement. Another parent who is an occupational therapist observed that her son had become aware of how his movements and posture affected the horse’s movement and was learning to control both as he became able to anticipate changes in speed and direction. “…you get too close to a horse and in somebody’s space.

and their willingness to participate on horseback coupled with their increased focus and attention span allows them to succeed. As a grandmother observed. “…like where his body is in space. “…they basically play…Red Light Green Light. and she’s on the horse and she’s got the whole nervous system involved. He used to just…run into things all the time…he would run into someone and look at them like…“Why did you run into me?” Focus. as described by one mother. concentration. Most of the children enjoy these mounted games. “I think…when he’s on the horse he concentrates better…the thing to me that’s…the most beneficial is that it causes him to focus…to train his mind to focus because that was a big problem. and lesson activities accordingly include many games and activities that involve completion of many multi-step directions.” 232 . And he just loves that. or focus in their children.aware of this. A desirable therapeutic riding goal for a majority of children in the study is the capability to complete two or three-step commands without prompting from the instructors or volunteers. it seems that she is more able to process that. so that when those directions are given to her.” Another mother has seen improvement in her daughter’s ability to follow directions and felt [she] was “…so interested and she’s so on task. And it’s neat because then he has to watch and pay attention and follow the directions.” Following directions. Seven of the children’s family members credited the therapeutic riding program with improved attention.

According to Executive Director Pat. it was notable in this study that four nonverbal children were reported to speak either their first words or meaningful sentences during a therapeutic riding lesson. Lehrman and Ross (2001) described gains in verbalization in a case study of a child with moderate mental retardation and visual impairment following a mounted equine therapy program. Although data regarding general communication skills are discussed in the social benefits section. Annie. and she considered this to be one of the major benefits of the program. “…and he’s increased his vocabulary in the last year.” Effect of horse’s movement and deep pressure. aged 9-11. We know it. Deficits in language development are classic symptoms of autistic disorders. but stressed that the boys were more motivated to participate in the hippotherapy program and discuss it with their friends. Many subjects felt these sensory experiences fulfill an innate need in the child with autistic disorders and can effect both cognitive and behavioral gains. in one of these situations. One father described his son’s transformation from 233 . the child’s first spoken sentence was. with language-learning disabilities.” referring to her horse. Although there are no related studies for this population. I mean it’s just amazing…And we know it’s from the horse therapy. An aunt was told by her nephew’s speech therapist that the horse’s motion would promote his speech. One recurring theme throughout the data refers to the perceived effects resulting from the unique sensory stimulation of the horse’s movement and the deep pressure experienced by the rider when mounted on the animal.Language development. Macauley and Gutierrez (2004) described self-reported gains from both a traditional therapy and a hippotherapy program for three boys. “I love you.

tantrum meltdown to total relaxation when he climbs aboard his horse. Although his son initially had difficulty with tactile sensitivity, one father later reported that he loves to ride, and seems to crave the deep impact the horse provides, “I think it goes back to…his sensory integration needs…because…to ride on the horse, especially at the faster paces, you’re going up and down and you’re bouncing and you’re getting deep pressure all up and down through the trunk…” Physical benefits. During normal child development, a reciprocal effect exists between attainment of physical and cognitive skills. Maturation of the brain is required for all factors that allow for motor growth such as sensory perception, balance, coordination, focus and memory. In turn, physical development stimulates expansion of cognitive abilities. Although physical deficits are not considered defining symptoms of ASD, lack of interest in interactive play at a young age and social withdrawal that restricts participation in physical activity as an older individual can result in a lifestyle that is lacking in appropriate levels of exercise and physical activity that contribute to optimum health. Therapeutic goals for several of the children in this study included enhancement of physical abilities. Opportunity for physical activity. One key word used by several parents was participation. Therapeutic riding provided a novel and enjoyable physical activity in which their children could take part, as many were not involved in any other sporting pursuit. One grandmother felt her granddaughter would likely not comprehend the theory of typical sports games well enough to play effectively, and besides that, “she’s not going to be picked for a team…”

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Gross motor function. Proper development of balance, strength and coordination are prerequisites to the acquisition of gross motor skills such as walking and running that are used in daily functioning. Riding class activities such as mounting and dismounting, standing up and balancing in the stirrups, swiveling in the saddle to face four different directions, and learning to center oneself in the saddle after leaning or reaching for an object during an exercise are designed to hone such basic abilities. Improvement in the clients’ core strength, muscle tone, balance, flexibility, and posture were all noted in the data. One instructor linked the importance of core strength to verbalization and thus to communication skills, which are particularly significant for children with ASD. Fine motor skills. Proper development of gross motor movements provides the foundation for acquisition of fine motor skills such as grasping objects or handwriting. MacKinnon et al (1995) found significant increases in grasping skill of subjects with cerebral palsy in a therapeutic riding program. Riders must maintain a grip on the bridle reins with their hands to help control the horse’s movements, and common activities routinely require the manual selection of objects such as balls and rings that will at some point be carried, placed or tossed. The riders may also be asked to reach forward and attach or remove colorful hair clips to the horse’s mane. They may manipulate various brushes and combs if assisting with grooming their mounts in the barn, or help buckle and unbuckle the horse’s tack, or riding equipment. One mother whose son had a very immature hand grasp noted improved strength in his grip that would promote his handwriting skills. An instructor explained how these acquired competencies can readily be transferred to

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functional life skills for children with autism, as one parent illustrated, “…he can now unbuckle the buckles on the saddle. That directly relates to the buckle on his belt. The fine motor skills directly correspond to…the Velcro on his shoes…” Endurance. Individuals who are not physically active typically lack endurance to resist fatigue and maintain exercise at an appropriate level. One mother had witnessed her son’s progress in this area, “…he used to get very, very tired…he’s always had very low endurance, but then in the first few classes, he’d make it out there maybe 20 minutes. And now he can go a full hour.” Toilet training. An important milestone in child development is toilet training, but delays in toileting are commonly reported in children with autism spectrum disorders. Three parents reported their children were much more aware of their need to eliminate soon after dismounting from their riding lesson, which substantially affected the general training process. One mother credited the novel stimulation, “…her pressure sitting on the seat is the only time that she was ever aware of any sensation…she would get off and you could see that she was uncomfortable and that’s how we started.” Decreased “stimming” behaviors. Classic symptoms of ASD include repetitive or stereotypical behaviors, commonly referred to as stimming (stimulation) by parents, instructors, volunteers and staff. Movements such as hand-flapping, toe-walking, hand-biting, or eyelash-pulling were frequently reported by family members of the subjects in this study. One family member noted marked improvement in her nephew’s ability to stand quietly and wait for

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his horse to approach the mounting block to begin the lesson, without repeatedly slapping his hands against his sides. Another noted a regression to these behaviors when her daughter was not riding during the winter months. Instructors theorized that the horse’s movement may satisfy an innate need for additional sensory stimulation in these children, as one teacher described a jumping, hand-flapping student who readily modifies that behavior when the horse is asked to walk at a faster pace, “…when they’re looking for that sensory input, they don’t have to move; the horse does it for them.” Riding skills. Beyond stated therapeutic gains, attainment of the skills needed to become a more effective rider was commonly observed by instructors, volunteers, and family members. As discussed in the psychological benefits section, progress in specific capabilities required by this discipline, just as in any sporting activity, typically exerts a major influence on psychological variables such as confidence, achievement, and pride, not only for the individual but also for the family and supporters. Overall physical well-being and transfer of skills to daily living. Ten family members in this study referred to gains in overall physical well-being for their children resulting from participation in the therapeutic riding program. Some felt the proficiency gained in therapeutic riding encouraged their children to become more physically active in general, and one mother felt the improvement in her son’s physical conditioning allowed him to focus more on social relationships. In a study of participants with cerebral palsy in a hippotherapy intervention, Casady and NicholsLarsen (2004) utilized the Pediatric Evaluation of Disability Inventory (PEDI) to find significant gains in total PEDI scores reflecting functional performance in the home and

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community. In their qualitative study of adults with schizophrenic spectrum disorders, Bizub, Joy, and Davidson (2003) found themes reflecting skill mastery and conquering of fears of riding that carried over into new activities, as well as positive effects of exercise on sleep, relaxation, and an overall sense of well-being following the subjects’ participation in a therapeutic riding program. Five parents in the current study spoke to their children’s sensory concerns related to aspects of physical activity that caused them to be hesitant in motor movement, fearful of heights or of being off the ground. Some had previously been afraid to navigate stairs, climb a ladder, or go down a slide, but displayed much less reservation to do so following their experience in therapeutic riding. One mother described how amazed she had been to watch her son, who had always been afraid to join his peers in a fast food playland, suddenly climb into the heights of the structure following the completion of his first full therapeutic riding program session. Another commonly expressed theme involved the children’s enthusiasm for riding which motivated them to comply with recommended therapeutic exercises much more readily than in their traditional occupational or physical therapy interventions. Social benefits. Development of appropriate social skills that allow individuals to successfully interact with others has a major impact on present and future mental health and level of functioning. Children who experience supportive, nurturing relationships with family members and peers are more likely to develop an ability to empathize with others and properly interpret social cues as they learn to play and work together effectively. Ageappropriate language skills naturally affect the ability to communicate with greater ease.

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Deficits in social interaction are one of the most classic features of autism spectrum disorders. From a young age, children with ASD may avoid direct eye contact, lack interest in imaginative or interactive play, and fail to develop the ability to take the perspective of others, which prohibits the development of empathy. Difficulties in the use or interpretation of both verbal and nonverbal language further restrict the individual’s social facility. A resulting lack of friendships with peers and general social isolation can negatively affect the attainment of optimal emotional health. Social isolation. Family members in this study described younger children who have no friends or playmates, and adolescents who spend all of their free time alone in their rooms. Although he has made much progress, the oldest participant’s (age 23) mother recalled past years when she could not force him into a new social situation, “He couldn’t handle birthday parties, even his own…we’d try to give a birthday party for him and have to take him home…he’d be the only one not there…” As a teacher of children with disabilities, she added this insight, “…I find it with so many of them that social isolation tends to exacerbate their problems.” Increased social opportunities and interactions. The therapeutic riding program provides ample opportunities for the clients to actively interact with not only the horses, but also instructors, volunteers, classmates, and family members of classmates. In the only published study on therapeutic riding for children with autism, Bass, Duchowny, and Llabre (2009) utilized the Social Responsiveness Scale to measure social functioning and found significant results in the area of social motivation, but not in social cognition and social awareness.

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which they do not always experience in other situations. Night of the Stars. Class activities are often structured to foster awareness of and encourage interaction with classmates. CKRH was the only place where he socialized with anyone. has also successfully included several of the clients with ASD as riders who present their mounts in the auction ring in front of a large audience during the bidding process for sponsorship funds.Depending on his or her level of experience. Family members were often pleasantly surprised at bonds their children formed with special instructors or volunteers. as in passing objects from rider to rider or performing as a team for a relay race. The consistently positive outreach of the staff and volunteers creates a supportive environment that is very welcoming to the clients. each child rides with a team at CKRH that may include a horse leader and one or two sidewalkers who serve to help maintain balance and stability while also reinforcing the instructor’s commands. CKRH also hosts non-riding events such as holiday parties for the clients. Efforts are made to establish reciprocal eye contact that is relatively easier. The organization’s annual fundraiser. especially with very young children. Encouragement of appropriate client communication is a crucial component of the therapeutic riding class protocol for children with ASD. Increased communication. “His biggest challenges are in the social area. Comments from family members such as. which provide an atypical venue in which to practice appropriate social behavior among familiar individuals. as the 240 . One mother remarked that in some periods of her son’s life.” or “Social [progress] has surprised me most of all” spoke to the significance of the facility’s endeavors.

One mother began to cry when she was told that her daughter had described a rubber ring as “purple” to a volunteer. One mother of a child who had not previously spoken much outside of the family recognized her son’s additional motivation to communicate his fears and his needs during one of his first riding classes. 241 . that was life-changing for this individual. And in that case.’…And he touched the mini’s eyes…That was huge.” There were reports of children speaking their first words or complete sentences during a lesson. “…I heard him say. as the girl had never before verbalized the names of colors. “…he just looked…at the mini’s eyes…and he said. I know it did transfer over to humans. ‘Oh my gosh!’ And so I was sobbing watching him on this horse…because I didn’t think he was going to do it.” Efforts in verbal communication are routinely reinforced by encouraging each rider to ask his horse to “Walk on” or “Whoa” before the horse’s leader assists them in controlling the animal. Some parents credited the personalized. Eyes. An instructor shared her unique experience with one child who suddenly became fascinated with his miniature horse’s eyes. ‘Walk on.’ I thought. and eventually might even occasionally share a smile. Volunteers are trained to keep instructions short to allow clients to more readily process commands. focused attention each child receives with eliciting greater communication. Children are often more motivated to communicate as part of an enjoyable task or game in which they enjoy participating.mounted child is seated closer to the eye level of the sidewalkers. Volunteers noted the necessity of a bathroom visit as another conversational motivator for clients. Instructors and volunteers remarked on the progress of clients who would initially refuse to make any eye contact. ‘Eyes.

Although horses do learn to understand vocal commands. animals…because their communication skills are so awkward. as one father remarked.” This provides an opportunity for the child to establish a relationship with the horse. as one mother explained. Clients must learn. helmet in hand. including ear positioning or facial expression. can be a novel experience for a child with ASD. One boy goes home after each lesson. This allows the rider and the horse to perform successfully together in a partnership while also remaining safe from injury. which.Children who are particularly interested in the horses themselves can readily find welcoming ears of others who share their passion at the riding facility. “…sometimes it’s hard for him to make that kind of…connection…with people. Instructors commented on the horse’s ability to provide immediate feedback to the signals provided by the rider. in order to correctly anticipate behavior and interpret the animal’s response to rider commands. “…he’s now getting the sense that it’s… not like your car…It’s not something where you just sit down and it goes…there’s another being there. Effective riders must learn to communicate with their animals in this manner and they must also become proficient in interpreting the horse’s body language. and not very skilled. but the characteristic social limitations of a child with ASD can 242 . Some children talk about their riding experiences or the horses outside of the CKRH facility. Interpersonal bonds are often formed when one becomes an accepted member of a group of any type.” Fit in as part of a team. they are instinctively more responsive to nonverbal cues such as squeezes from the rider’s leg or pressure on their heads or mouths from the bridle and reins. with horses. and talks to his neighbors about his horse.

A male student doubted his own capability to compete in the Special Olympics. this common developmental construct may play a positive motivational role when members of a riding class work as a unit to encourage reluctant individuals to participate fully in class activities. Participation with others from the same riding class in activities such as the CKRH fundraiser. Learning to place trust in another individual is an essential aspect of relationshipbuilding. Although children with ASD may not typically be affected by peer pressure. Learn to trust others. but Program Director Denise recalled that his instructor convinced him to enter. One girl who exhibited extreme fear in her early lessons had been brought along very gradually and was eventually able to mount a horse for the first time.” Forming bonds and relationships.severely limit this type of association. particularly if they are initially reluctant or frightened. Deficits in social interaction skills often restrict the child with ASD from establishing meaningful personal relationships outside of the family. Instructors indicated the facility attempts to address this need by providing each child a consistent team of supportive volunteers with whom the child can become comfortable. Her instructor believes the progress that has been made is due to their shared positive rapport and the client’s trust in her teacher. The young man told his mother. “‘Well Alan must really believe that I can do this’…and then he goes to Special Olympics and he wins a gold medal!…Alan believed that he could do this…and he transmitted that and he did it. and it is crucial that clients develop trust in their instructors and their team members as they hone their riding skills. can provide a common experience that could potentially be shared in a peer relationship. Night of the Stars. Some of the 243 .

” Stressing the importance of the comfort level an instructor has with students with autism. One grandmother made note of the special relationship with an instructor who is able to identify subtle differences in her granddaughter’s moods. however. are carefully matched to clients based on individual needs and personality. She pretty much focuses on Ms. a step-mother commented on her step-daughter’s singular focus on her own instructor. “And this is my other dad.younger children in the therapeutic riding program were reported to display little interest in playing with peers and making friends. Mary. possibly due to his frustration at only having one or two valued personal relationships in his life. it can upset the child with ASD who relies heavily on established routines. Instructor and volunteer teams. as in the case of one boy who was matched with the same volunteer for all six of his riding sessions. Significant client/volunteer relationships do exist. and one older client has on occasion exhibited aggressive behaviors. The same child introduced the instructor’s husband as. Thirteen of the 15 children’s family members described strong attachments with the child’s riding instructor. “…she really doesn’t give anybody else much mind. as well as the horse. perhaps due to less direct personal contact or the necessity of rescheduling volunteer team assignments more often over successive sessions. Not uncommonly. Doug. When team member substitutions do become necessary. and every effort is made to maintain the continuity of the group to foster familiarity. however. particularly if a volunteer can remain with the same child over time. the children form attachments with caring instructors or volunteers.” Children reportedly were less likely to bond with their team volunteers than their instructors. or if the volunteer makes an especially strong 244 . Bonding with instructors and volunteers.

One client was excited to recognize a former schoolmate in his riding class and regularly made a point of greeting both the peer and his father. however. One child enjoyed a reciprocal relationship with a volunteer who always provided enthusiastic encouragement. and as each client learns to correctly interpret the horse’s reactions to his or her cues. Although the riders do not have as much direct contact with their classmates as their team members and instructors. “And I thought. The horse is non-judgmental and excels at reading the nonverbal language of his handlers. There were instances where children who shared a common bond through their riding classes spent time together outside of class as well. Beyond human relationships.effort to consistently recognize and converse with the client. Variability exists concerning the riders’ degree of attachment to their mounts. such as two girls who greeted one another with a hug. Some are very fond of their animals while others seem to appreciate the horses only for the 245 . ‘This is the first time he’s had a relationship with another adult that’s not my husband or me’” Bonding with classmates. several parents noted some degree of interaction with their riding peers. his mother confided. perhaps the most unique aspect offered by the therapeutic riding intervention is the opportunity to form a partnership with the horse itself. After relating her son’s continual efforts to please this volunteer. Bonding with horses. he or she is constantly challenged to supply the next appropriate cue required to successfully maneuver the horse as instructed in this reciprocal relationship. Another child made some friends when he was placed in a class with riders closer to his own age than in his previous class.

One rider apparently appreciated the role his horse played in his victory at the Special Olympics. He wanted to do that. “And …one day he broke loose from [the volunteer] and ran over and just hugged Socie himself. Another client initially refused to compete in the Special Olympics after he was told his regular mount that he trusted could not be used for the event. “…just the relationship between the child and the animals…I think that will carry over into…his relationship with kids and people in general…” The magic of the horse. While family members acknowledged several qualities of the horse that attract their children to this type of intervention. As one mother commented. as he asked to go back to the barn after the competition so he could pet his horse and have their picture taken together with his medal. Some riders overcame an initial fear with careful instructor management.experience they provide. young adults…different than soccer because you’re dealing with another live creature and that gives you some sort of…a connection. the subjects who work directly with the animals suggested the existence of an indefinable quality the horse possesses that cannot be replicated with a human or any other animal.” Family members valued the unique opportunity the therapeutic riding intervention offers to help their children learn to deal effectively with an animal. “I would say that it’s good for kids. According to one instructor. Some children refer to their mount as their horse when away from the facility. One boy who was terrified of horses at first was later observed to demonstrate true affection to his equine partner. “…there’s a connection that the horse and the rider have…that people don’t even have with each 246 .” and another expressed her hope. without being instructed to.

and give their horse a pat. Red stops…if Red even thinks that his rider is uncomfortable…he gets this furrowed-brow look on his face. One mother pointed out that in other settings. ‘Walk on. Riders may demonstrate close associations with their mounts. well then we just move on. “…there’s a certain magic and a certain energy between certain people and certain horses…” Another instructor feels one of her lesson horses can be relied upon to alert her to a student experiencing difficulties. Practice appropriate social behaviors. “if his…rider is starting to go off balance. the relationship between client and horse is a two-way street. but…out here…they don’t walk the horse on until he says. Family members were grateful for their children to be routinely encouraged to look directly at and greet people. he’s just so concerned…it’s written all over his face…” From the perspective of the horse handlers.’” One client whose initial inclination was to regularly 247 . An instructor pointed out that at the end of each lesson the students are asked to thank their volunteers and their horses. “…if he doesn’t say it. While children with ASD may typically lack the innate consideration for others that provides a natural basis for standard social graces and courtesy. facial expression and movement is transformed for one client only.’ because they know he’s capable of saying ‘Walk on. the child’s instructor stressed. they can learn to implement conventional social conduct through modeling and repetition. In describing one normally sour horse whose attitude.other…” Some theorized that a stronger bond is formed when an interactive training relationship exists between horse and human. but in many instances horses have also been observed to show a special affinity for the children they are carrying.

punch both his team and his horse with his fists was eventually redirected with success to more appropriate behavior. or is each one necessary for the success of this intervention? One instructor summed up the thoughts of several relative to the overall goals of the therapeutic riding program. As an individual ages. and industry. Sadock & Sadock. Erik Erikson’s theory of personality development (Edelman & Mandle. Children with ASD do not necessarily follow these same developmental patterns and often display abnormal behaviors and social deficits (American Psychiatric Association. 2002) was utilized to organize the many constructs relating to psychological benefits that were presented in the data. 2000. initiative. to me is…a huge success. Is one type of relationship more effective. 2004). The development of positive self-concept begins in the first two years of life and continues on through adolescence (Berk. and is affected by a great number of 248 . “The fact that we’re talking about the human relationships. Confidence. maturation occurs at variable rates in the general categories of sense of self.” Psychological benefits. moral development. Self-concept. and that speaks to the horse. Horses or humans? There is interaction at the CKRH program between both clients and other people and clients and horses. 2003) that could cause adjustment problems and preclude optimal emotional health. self-control. because…we’ve got the activity with the horse that has brought us up to the human interaction.

“…he’ll have his riding helmet in his hand and he will tell every neighbor that is outside…that he was riding his horse. Three parents referred to their children’s gains in independence through the program. ‘I deserve that.” After congratulating her daughter on a particular accomplishment following a lesson.” reported one mother. So he loves it and he thinks he’s big stuff. her stepmother described her reaction to the compliment. 2004) that was noted by family members of seven of the children. A mother had observed upon their arrival home after a lesson.” a more advanced class. Independence.’ I’d never known her capable of that emotion and I saw it in her face. Pride. One instructor described an instance where one non-verbal rider repeatedly appeared to assert her desire for greater autonomy by reaching down and attempting to disrupt the side walker’s handhold on her thigh. The therapeutic riding program provides external recognition and the positive feedback that helps to promote a sense of pride (Beck.variables. “…it was the kind of look you get from a kid that feels like. The therapeutic riding experience was also favorably compared to team sports in providing the opportunity for greater self-sufficiency. I’m proud of myself too. Parents of 11 children associated gains in confidence with the therapeutic riding program. and instructors frequently mentioned a common desire for students to aspire to more independent riding “in Alan’s class. “He thinks he’s bigger than the world…he rides a horse and no one else he knows rides one.” 249 . The ability to carry newly-developed confidence into other areas of life may be the most significant benefit. so he’s got one up on everybody.

development of a sense of social worth can be especially problematic for children with ASD. Due to the characteristic limitations of this condition.” 250 . Because their children typically have fewer potential pathways to success available to them. I don’t think.” Self-esteem. which was observed by 11 family members.” One instructor’s encouragement to compete in the Special Olympics inspired one client to tell his mother.Achievement. physical or social realms. She’s not going to have any…athletic achievements. “‘Mommy. Positive self-esteem is a most crucial precursor to overall psychological adjustment and thus directly affects patterns of behavior. “Mom…somebody thinks I can actually do something right…I guess maybe I am…good at something. She’s not going to go to college…” One mother was especially cognizant of the program’s potential benefits as she recalled her son’s plaintive. Self-concept is also bolstered by a sense of capability and competency gained through personal achievement.’ because…no matter how hard he tried to win a race or…play basketball…he always lost…how horrible for a child that. “These are the high points in her life. I’m such a loser. Six family members reported gains in this area with comments such as. family members feel the value of each triumph is magnified. they always come in last. because she’s not going to have…academic achievements. And here…he’s good at it. One boy was able to earn a horsemanship badge in Boy Scouts. Beck (2004) defines the concept of self-esteem as self-evaluation of personal value or worth in academic. “There has been nothing else I have ever seen that has made her feel as good about herself. no matter how hard they try.

. Individuals with ASD are not typically in charge of their own lives.” Even the unique perspective provided by the relative size of the horse can play a role in the heightened sense of command. where a lot of times he’s just completely out of control…it gives him a lot of support. Instructors. ‘O.K. Lewis.’ Hugely empowering…” 251 . testified repeatedly to the powerful effect derived from an individual learning to take charge of his horse and exert some degree of control over the animal.Locus of control. as well as seven family members. but Executive Director Pat spoke to the potential for development of both personal control and command over the horse that “gives a real sense of empowerment…to children. as explained by a volunteer. and makes a focus outside of themselves. “…they’re sitting in a world up above the world now…looking down at everybody else. Empowerment can be defined as an enabling process through which an individual gains a generalized sense of control over his life and his environment (Glanz.” One instructor depicted the children as having things routinely done to them and decisions made for them. & Rimer.” Empowerment. any time you can get a kid up on a horse and let him think he’s in control of a situation. 1990). Internal locus of control refers to an individual’s belief in his ability to direct his own actions and take credit for his own successes (Edelman & Mandle. “…you put ‘em on a 1200-pound animal and go. “Well. until. you’re the boss. and they feel like maybe they have some control over their lives that they don’t have in their normal day to day existence. 2002). rather than be manipulated by external forces beyond his control. volunteers and staff members.

” or “…he starts learning to buckle and unbuckle because he really wanted to help with the saddling of his horse and hanging up the saddle. brushing his own hair…He had never done that before. but children with ASD often display little interest in such self-care.We have…seen such 252 . The ability to control emotions and reactions to environmental stimuli begins to emerge in the first two years of life and continues into early childhood (Berk. “So he was brushing the horse and helping with bathing. Four of the children in the study overcame fear of the facility environment or the horses themselves before they could progress. And the next thing I know..” Emotional self-regulation. Children must learn to evaluate perceived threats and respond appropriately. he’s at home all day looking in the mirror. 2004. Unanticipated yet valuable transfer of personal care skills appeared to be motivated from an interest in assisting with care of their horses. “…before we started. Zentner & Yakimo. Well the next thing I know. According to his aunt.Self-care. self-regulation can remain a major challenge to the acquisition of functional social skills as they mature. he’s buckling his own buckle. Murray.. Failure to modify irrational fears can sometimes restrict the ability to achieve constructive goals. 2009). Because children with ASD commonly exhibit sensory hypersensitivity and a range of inappropriate behaviors. one boy experienced a reversal in his reaction to animals in general after learning to accept his therapy horse. Control of emotions and overcoming fear. he wouldn’t touch any animal. usually with the help of a carefully planned gradual desensitization approach. Activities such as personal grooming and dressing contribute to self-concept in the younger child.

focused. one mother related. as one mother conveyed.a big difference in…how he relates to animals…when I see that I know it’s from Socie. does what he needs to do. and happy…” Some theorized that the movement of the horse is responsible for such transformations.” Less inappropriate behavior. And he gets on the horse and we go home and it’s…just like a typical. Several examples were given in which structured behavioral plans developed with family members were successfully utilized by instructors and volunteers when outbursts occurred during class. Calming effect. even keel. The most impressive victory may involve the behavior modification with the boy who initially hit his mount with his fist 103 times during the 30 minute lesson. It’s from his involvement with an animal. In crediting this as the biggest bonus for her child.” Another mother also referred to the somewhat tranquilizing effect on her son following “…a really rotten day…being physically aggressive or just off the charts. Although modification of less desirable behaviors often takes time. Eight family members and numerous instructors and staff members emphasized the use of the horse as an important component in the combination of strategies designed to reduce the number of inappropriate behaviors and meltdowns so often displayed by clients with ASD. being allowed to remain in class and continue riding the horse was the strongest motivator to a productive resolution. a notably immediate calming effect related to riding was also reported by family members of six children as well as volunteers and instructors. “he just kind of sinks into the horse…He can be real hyper and he gets on the horse and…you can physically see him…just kind of melt. In most cases. “…autistic kids have 253 . typical kid.

I think it interests him enough to try something different outside of his comfort zone. As the children gained confidence and greater acuity in their horse handling skills. and possibly to transfer that achievement to other areas.” Initiative. And…so the movement of the horse…maybe mimics…his self-stimulating…” and another mother expanded on the premise that there is “…something inherently wonderful about a horse… and a horse’s ability to help children…and it’s something about their movement or something…just in their nature that is just…relaxing.things that they do to calm. Five parents related experiences that had created obstacles for their children. and even a forced detour to the riding facility through an unfamiliar entrance to the Kentucky Horse Park.” Transitions. That helps him calm. Growth in self-control also includes the ability to deal effectively with change. and dependability beginning in early childhood (Murray et al. 2009). assertiveness. they were much more capable of taking charge of their animals and completing 254 . The concept of initiative involves the emergence of learning. which is very difficult for children with ASD who are notoriously dependent on a strict routine. Like when [he] gets upset. “…he normally wouldn’t like things that are outside of his routine or what he’s accustomed to.. as one mother shared. The children’s motivation to participate in their riding classes enabled them to overcome their discomfort in each case. he’ll rock…he likes that movement. calming…and therapeutic. such as changes in instructors. determining plans of action. or horses. but being able to do the riding. team members. however.

perseverance. In order for goals to be rewarding. “…he’s now getting the sense that…it’s not like your car…where you just sit down and it goes…you have to maintain it and…there’s another being there…that needs care as well…And some responsibility involved with it…so it’s been wonderful.assigned tasks or maneuvers with limited supervision from instructors and team members. One mother noted her son’s progress in skill levels through several riding session. instructors and volunteers also emphasize proper treatment of the animals that make that experience possible.” Another mother pointed out that children with ASD “…may be less likely to try new 255 . Challenge. Moral development and responsibility. Experiences that allow for acquisition of these traits encourage the individual to continue to pursue additional challenges. “…he gets better each time. and the ability to problem-solve (Berk. The construct of industry includes values required for achievement such as task mastery. so I think they want to challenge him and give him a horse that will challenge him a little more. they must be both desirable and achievable. Children traditionally learn morally-relevant behaviors through imitation of others and positive reinforcement (Berk. 2004. 2004) that will ideally evolve into the acquired traits of trustworthiness and responsibility. The therapeutic riding environment provides challenges that are carefully structured to be increasingly difficult yet attainable for each client. Murray et al.” Industry. 2009). Beyond teaching riding skills.. A father appreciated his son’s growth in this area.

Specific objectives are formulated and instructor evaluations are recorded in CKRH lesson plans for each individual. “So I think he’s actually going to become a rider now.things or be in new situations. Four family members remarked on their children’s progress in task mastery. A father confessed. rather than just…doing…mostly I think therapeutic skills. emotionally. One father noted his son’s progress in the past year. “…he’s really…moved beyond just riding to really trying to learn the skills and ‘Whoa’s’ and stops and starts and rights and lefts and leading and steering the horse…he’s really blossomed his skill sets…” One mother was appreciative of the staff’s concern for her son’s continued advancement. so something that motivates…that’s very good for them to be in a new place…and be challenged to do things beyond their comfort zone. “…one of my struggles.” A mother echoed that sentiment concerning programming for her son.” where they can ride more independently. selfconcept.” Instructors and staff mentioned the strong motivation for clients to sufficiently master the basic riding skill so they can be assigned to “Alan’s class. Nine family members spoke to the significance of their children’s involvement in therapeutic riding. “…this has been the one constant that he’s always looked 256 . had always been that she has enough structure and programming in her life outside of school…having an event every week to look forward to…it’s one more thing to make her life that much more full. Participation.” Task mastery. and identity formation. Children with ASD classically demonstrate limited interest in participation in activities that could provide opportunities for enhanced achievement. task mastery.

” Another boy’s reaction is similar. “He owns it…I think most kids [with ASD] face the same thing [he] does. whether horses are a personal obsession or just provide an enjoyable experience as well as therapeutic intervention. Excelling in a relatively uncommon sport that requires a high level of skill can make a positive contribution to identity formation. “…he’s 257 .” Opportunities to take part in the Special Olympics or the CKRH fund raiser. “…he gets up there and stands like a jockey and he wants to do it and he’s good at it and his peers are not…he does something that they’re not able to do…” Enjoyable activity that makes child happy. “…so for him to get excited about something was a big deal…He got on the horse the first time and just didn’t want to get off…he loves it. Identity formation. Night of the Stars were also mentioned.” Although some of the children displayed an obsessive interest in horses. a girl’s mother was surprised to find that riding became “…the first time she had shown an interest in…something besides…immediate family. [Or] an inanimate object. Nine parents emphasized the importance of children with ASD having an interest or activity that is their thing.” The fact that horseback riding is a rather unique pursuit only strengthens the effect. as described by one mother.forward to…very little has kept him off the horse. For a therapeutic activity to be not only beneficial but also fun for the child as well was considered an obvious bonus. Every family interviewed referred to therapeutic riding as an activity that their child enjoys very much. This interest was especially notable to family members because their children are not typically attracted to many hobbies or pastimes. as his mother describes. They feel like outsiders and that they don’t fit in. as another mother declared.

One pediatrician’s response when speech therapy 258 . And to see that kind of happiness in those children…it puts them on an even playing field. maybe up. The diagnosis of autism spectrum disorders. and he’s excited on his way home…it’s an overall…love of his. Family members described subtle early symptoms such as language delay or lack of personal response and interaction that caused them to initially suspect ASD and to eventually seek medical evaluation. Some family members were often understandably tempted to attribute such signs to other conditions than ASD. Parental challenges.excited in the car on the way here. as related by a volunteer. Interestingly. Personal insights into the challenges of raising children with autism spectrum disorders were also considered valuable. An unexpected consequence of the current study was the collection of data related to the multiple benefits received by parents and caregivers as a result of their children’s participation in the therapeutic riding program. The opportunity to ride the horse at the increased speed of the trotting gait regularly produces big smiles and frequent gales of laughter from the riders.” Family benefits. he’s excited while he’s here.” Caretakers often find it difficult to motivate their children to get prepared to leave for an outing. but no one reported an issue with the riding lessons. with even the less verbal children readily assembling the necessary clothing or equipment when the trip to the Horse Park was announced. or not necessarily even. They laugh…some of them laugh so hard they can’t catch their breath. parents were sometimes met with resistance from their children’s physicians to provide a referral for early intervention or further testing. “They get so happy.

Parents and family members shared their initial reactions to the diagnosis of autism spectrum disorders.” from the mother of a 23 year-old. there is still a lack of knowledge or recommendations for coping skills that leads to frustration for caretakers. I think initially. you don’t want to do that. new developments as your child ages. Commonly repeated themes included the dismay experienced by family members at the incomprehensible reversal of their children’s apparently normal development at an early age. “‘Oh no.was requested for a child was. Although there is now a much greater awareness of this condition. or “The grief cycle never ends. you just continue to face new challenges. Reaction to diagnosis and grief issues. who warned her that her son would probably be institutionalized as an adult. The mother of the oldest child in the study (age 23) received the diagnosis twenty years ago with little encouragement for any type of treatment at that time from the neurologist.” from a grandfather of a 4 year-old. “…we were in grief. That will be just too emotionally scarring for him. “‘…you know what’s really emotionally scarring is that he talks to kids and they don’t understand him and they walk away.” to which the mother replied. But there is no steady path to improvement. the waiting period could be as long as 12 months. followed by a gradual transition to acceptance of the condition and its “roller coaster ride” with hope for the future. 259 .’” When a referral for further evaluation was obtained for a child. once we realized what the condition was.

gosh. You have no concept. Frustrated. ‘You need to wear her out’…and…I thought to myself. as described by a grandmother. You must not be disciplining your child…or they wouldn’t be behaving this way. Symptoms of ASD are not always consistently apparent or readily identifiable. Program Director Denise introduced the concept of victim blaming when she acknowledged a more predictable sympathetic reaction to an obvious physical disability versus that directed at a less familiar mental health condition that may be misinterpreted as a simple lack of discipline on the part of the parents. and here’s their websites or here’s their phone 260 . Family members are often subjected to judgments from unenlightened strangers with no understanding of their children’s aberrant behavioral issues.’” Proactive riding instructors spoke to the need for heightened awareness and empathy for this condition within the general public. “…So there’s a lot of blame…there’s a lot of expectation of if you did this differently…you would behave differently…you must be a bad parent. A riding instructor described. ‘…You’re just ignorant. this. all family members interviewed for this study were unconditionally devoted to the pursuit of appropriate interventions for their children. they’re fighting a system. proactive parents have searched for effective interventions. and this.” The mother of two boys with ASD expressed her frustration. they’re fighting. Despite a dearth of information and recommendations for the treatment of ASD. trying to obtain services. “There’s no handbook out there…that says… ‘Hey. this.Reactions of outsiders. They’re fighting to get in the school systems…they’re fighting with the insurance companies to get them to pay for services. you ought to try this. “…I remember these people walking by and saying. “…so many times and so many different places.

So…it’s by word of mouth. so parents and family members try to address the symptoms and set realistic goals for their children. “…if somebody told me that it might work. I went for it…You…chase down the therapies and the recreational things that…keep him functioning.” while a mother set an age-specific goal. even.” The support and dedication of family was evident in all cases.” Goal is best life for child to “be all they can be. “We’re always trying to think of new things…I just felt like it was our obligation to expose her to this and to give her a chance to see what she could do.when you have a child like that…you’re grasping for any and everything …that you possibly can..” One mother has found her most reliable sources are peers who share the same issues because. “I want to give him an opportunity to fully explore…being an 11 year old. and I was just horrified. “…it was…a shock to me to find out that…they haven’t figured out…exactly how to teach children with these disabilities. “…we have a lot of hope for him to…fit in. “…the schools don’t tell you and doctors don’t necessarily know. and that’s too bad. One grandmother anticipated social acceptance.” With little guidance available. some parents feel their only option is to become very proactive and coordinate their child’s treatment plan themselves.” At this time these is no known cause and no known cure for autism spectrum disorders.numbers’…You’re just kind of left to…find your way. One mother interviewed for the study is also a preschool teacher who was surprised to find her formal education courses were of little benefit in this regard..” One mother enrolled her son in therapeutic riding even before he was diagnosed.” or “We’re just trying and struggling to get her whatever it takes…to try to help her.” The many sacrifices these 261 .

but for family members to witness this success in a challenging activity. Normalizing activity / more typical child. “because…of course you want to do everything you can for your own child…I just want my son to be happy. “I mean she has far surpassed…anything we thought her capable of.” See child achieve. when their parents look across. as one mother explained. “It normalizes something in their life……When they’re on horseback. They’re just taking a riding lesson. Four parents agreed with this assertion. The researcher was fortunate to observe an overwhelmingly joyous reaction during an interview with both parents as they witnessed their daughter mounting her horse for the first time.” One instructor has viewed therapeutic riding as a chance for children with ASD to take part in a more typical children’s activity.” Another parent was especially cognizant of her daughter’s more conventional experience at CKRH. The therapeutic riding program offers not only a chance for the child with ASD to experience a sense of achievement. his mother smiled proudly and said.” and the father agreed. “And in ten 262 . “Other kids play…t-ball…and so it gives him that ability to do what a typical child does.” Benefits to parents. as she had an older son with a condition similar to autism that “never fit in anywhere. they’re like every other child on horseback.” As a child walked back from the riding ring following his lesson. The step-mother expressed her joy. “…as his mother I feel like it’s my responsibility to give him the best life I can… You grit your teeth and you do what you have to do. and to be able to function in life. as well as the motivation to do so.parents and family members make on a daily basis were clearly evident.

this is…where they see it. Pat was rewarded for her decision to include clients with ASD as participants in the annual public fundraiser. Denise derives personal satisfaction from helping to provide this opportunity for the families of children with ASD to witness their children’s small victories. I would have said you’re crazy. One father whose son was chosen to compete remarked. “…we’re just so grateful that she got to be queen for the night.” Pride in child / limited opportunities for participation or success. where for some of our parents.” As Executive Director. beyond their weekly riding classes. 263 . Night of the Stars. “…to watch their child…succeed…is for me…a very…awesome experience because…a lot of people see…their son makes the touchdown or…a lot of parents see it on a regular basis. Parents who have witnessed their children’s achievement also expressed the feeling of pride in their accomplishments. when they are more accustomed to being told that their children are not capable. “…he’s going to be a shining example for CKRH and I’m very proud of him.” As Program Director.” Executive Director. as parents had explained to her. and extended family can take part in the experience. or he got to be king of the mountain…[we could] go out there and applaud and…take a real sense of pride in the accomplishments.sessions…if you had told me she’d be leading a horse around on her own and mount one. The Special Olympics equestrian competition held each fall at the Kentucky Horse Park provides an additional occasion for the children to shine. Pat receives “a gazillion” phone calls from family members poring over details such as selection of proper apparel for these events.

Denise has a great deal of interaction with family members. The therapeutic riding program elicits happiness not only in the riders. One instructor recalled a compliment from one mother on the patience she had displayed with her daughter. “…I got the very distinct impression…that…a lot of people …rushed her…didn’t take time to let her process and sequence all of her events…and I think…that’s one thing we all have in common here. “…you can look over there for one hour and see the parents grinning from ear to ear and watching their kid ride. “I have yet to hear a parent who is not happy that their kids are here. to get therapy on top of it is so exciting. “…even when he gets explosive…they all handle it very appropriately and nobody gets frustrated with the fact 264 . knowledgeable and capable instructors and volunteers during each trip to the CKRH facility. but also in their supporters. Caregivers are relieved to be able to place their children under the care of patient. ‘Wow. The mother of a boy with very aggressive tendencies was especially grateful. “I see my child so happy every time…and the excitement just in his little body…I would still be just as ecstatic.” Serving as both Program Director and as an instructor. but to…have him love something so much.” Family members also praised the ability to accept the riders’ limitations and help them to reach their potential. my child can do this.” Supportive environment.Makes parents happy. “…and then the next thing that I see…is just the satisfaction and the pride and the amazement that. as Shirley noted. Volunteers are particularly aware of such reactions in the family members.’” One mother would recommend the CKRH riding program even if it didn’t provide the therapeutic interventions.” Jo Ann enjoys talking with parents between classes.

I don’t have to worry about what’s going on with…my special need child…so it’s just nice to be able to sit for an hour…just…relax and not have to worry about him taking off. One unanticipated consequence of a therapeutic riding lesson for family members is.that…they’ve just been socked in the head again…” A mother of two sons at opposite ends of the autism spectrum values the supportive environment which includes the staff’s willingness to treat each child as an individual. it’s the family…” Another mother depicted a collaboration between the CKRH facility and each child’s caregivers. “…oh my gosh. I can relax. a medical history from the child’s physician. evidence emerged to suggest that the therapeutic riding program offered benefits not only to participants but also to their family members. 265 . It’s the parents. as one mother testified. Only instructors have access to each child’s complete file for lesson planning purposes. Throughout the data collection. “…it is therapeutic in all areas…and it’s not just for the child.” One mother had recently discussed the advantage of having “adult time” in which they can share stories with two of the other parents. and how can we help…[each one] along…you don’t have to worry about if your kid’s doing something strange…you know you’re welcomed here. “the folks here are just so adept at…truly trying to measure each child. and an on-site evaluation of the child so he or she can be placed in a class situation most appropriate for the stated goals. I’ve got people who understand…” Staff members described the application process that requires a written assessment from parents or caregivers. I’ve got friends. “…it also gives the parents a break. “…you…feel like it’s family and you really enjoy that…it’s a partnership…I feel like when I come out here…I’ve got partners. I’ve got support system.” Caring for a special needs child can require a significant input of energy from all family members on a daily basis.

Instructors strive to establish a rapport with parents or caregivers. I mean they have to be. Ongoing communication between CKRH staff. “…I don’t know what goes on at their homes…but just to see them…I think the parents of these children are really special as well. Such close relationships between CKRH personnel and the client’s team of supporters allow for a glimpse into the atypical lives of the children’s families and the development of a mutual respect.” Beyond the relationship established between the CKRH facility and the children’s caregivers is the informal family support network created simply through the gathering of family members during the children’s lessons. or the need to follow a consistent routine prior to each lesson to prevent outbursts. One mother supported that concept. Volunteers who are in direct contact with the clients during a lesson are especially appreciative of both the Rider-at-a-Glance cards and any useful input or suggestions they receive from family members Instructors’ and volunteers’ involvement with the clients sometimes extends beyond the lesson ring. as noted by volunteer Perry.but volunteers have now been provided with Rider-at-a-Glance cards that have been developed with input from each child’s parents. school teachers and other professionals. helmet-wearing compliance. Several examples were given to illustrate the effective use of these behavioral plans. and contain the individual’s lesson goals and any recommended behavioral plans. “It’s therapy for everybody…There’s a lot of networking that goes on…In that hour of time where your kid’s on the horse and you’re sitting there…I have gotten so much 266 . instructors. involving a variety of scenarios including temper tantrums. volunteers and caregivers is considered vital to maintaining an effective therapeutic relationship.

“…a lot of things happen at the picnic table.as parents are watching the lessons…they start to really share…resources…it’s everything from soup to nuts.that we worked through that plan…I don’t think…the families ever really thought that these individuals would be riding a horse.” A father feels his years of experience with his son can help him make a meaningful contribution. Program Director and instructor Denise summarized the typical reaction of parents of some of the more behaviorally-challenged clients following a careful introduction to the riding intervention..information..” Program exceeded expectations. “…I’m tickled just to be able to give back and come up with something that might help other kids.. but it’s a resource…I think a lot of the best stuff is at the picnic table. but reported a very positive experience for him. “…what I see is just total surprise and amazement..” Parents give back as volunteers. as one mother explained. “… it’s rewarding to me to be able to help kids like [my son]. Other clients realized more dramatic turnarounds. Parents and caregivers of 11 of the 15 children stated that the therapeutic riding program had exceeded their initial expectations. Some parents derive satisfaction from volunteering in the CKRH program. such as the mother who had low expectations following her son’s physical attacks on staff members during his initial evaluation.” 267 . One student overcame his sensory sensitivity to the extent that the family could finally have a puppy. So much.” Executive Director Pat further elaborated on the phenomenon informally referred to as the “picnic table support group.

“…I just didn’t dream of all the things that would improve…after all these years of therapeutic interventions..” Activity family can do together.” Another parent felt parents of children with ASD may be unaware of the extent of services provided by the therapeutic riding program.. feeling it is designed only for children with physical disabilities. Executive Director Pat tells caregivers of children with ASD that there is a good chance they can be helped in some way as she recalled. as Executive Director Pat acknowledged. Parents of three children reported gains in toilet training they credited to the therapeutic riding experience. In some cases. Toilet training.Family members frequently recommend the program to other parents.just learning to sit up and ride the horse is so huge. One mother signed herself and her horse-crazy daughter up as 268 . However. While recognizing that not all clients achieve the same level of success. one parent stays with the child at the lesson ring while the other parent spends time with the siblings on the grounds of the Kentucky Horse Park. success in toileting can also be considered a benefit to other members of the household. Caregivers conveyed ways in which the therapeutic riding program experience could become a shared family experience.. But when that child is able to sit on the potty it’s a life change for the families. “I cannot think of one of our autistic patients that hasn’t achieved some benefit from this.” Benefits to family. One mother favorably compared this activity to other therapies they have tried. which is discussed in more detail in the physical benefits section. “.

Laliberte. Sibling issues / child has own activity. but his mother thinks his success in riding has helped him deal with that performance disparity. Five parents commented on the issue of achieving a balance. who described her daughter’s reaction watching her brother in the riding classes. So…this is his thing and he’s proud of it.CKRH volunteers so the daughter could be involved while her brother rode. A grandmother echoed this sentiment. The mother of two sons enrolled in the program appreciates that the brothers can share this experience. “And I…really enjoy the fact that…the boys can do something together…it gives them a little bit of a bond together…so it’s been a great experience…” The boys’ sister also regards the CKRH Christmas party as one of the year’s social highlights. Noh. including Robin’s mother. “[He] doesn’t get frustrated anymore. and Allan (1995) 269 .” Discussion Physical aspects of disability for individuals diagnosed with cerebral palsy have received the most attention in the limited research regarding the benefits of equineassisted therapies. Lariviere. Although MacKinnon. “…her brother is real good in sports and all this stuff…so this gives her something too…” One boy has to compete with his more capable younger brother in gymnastics class. Dealing with sibling rivalry can be even more challenging in a household that includes a special needs child.” The mother whose daughter volunteers in the CKRH barn reports. “…she’s involved in a lot…and has been pretty successful and…since [her brother] doesn’t do anything…he feels like he doesn’t get the same amount of praise as what his sister does. “…it just kills her…because she wants to do it too…it’s the one thing we keep special for him. like he used to…this he knows he does well.

Duchowny and Llabre (2009) presented the results of the first study of social functioning for children with ASD in a therapeutic riding program. Davis et al. Leung. health. and Vokes (2002) and Cherng. Liao. significant results were noted in areas of sensory sensitivity and integration. strength.found no significant results in quantitative measurements of gross motor function in subjects with cerebral palsy in a therapeutic riding program. Although finding no significant increases in GMFM. In a study of subjects with developmental delays. Bass. Winchester. and seated posture. decreased inattention and distractibility. qualitative measures described steady progress in the areas of core strength. or quality of life measures for subjects with cerebral palsy participating in a therapeutic riding program in 2008. balance. but peer- 270 . Initially citing two animal-assisted therapy studies for children with ASD that demonstrated increased use of language and social interaction in the presence of live dogs. and Hwang (2004) reported significant increases in Gross Motor Function Measure (GMFM) scores following a therapeutic riding intervention for subjects with cerebral palsy. Extensive anecdotal evidence of the many purported favorable outcomes of therapeutic riding programs has promoted the enrollment of ever-increasing numbers of children with ASD whose caregivers hope will profit from this intervention. directed attention. Peters. Utilizing quantitative measures of sensory processing as related to social function. Sears. and Winkley (2002) demonstrated significant improvement in GMFM scores in a therapeutic riding program. France. Rogers. Kendall. and social motivation.’s qualitative data from primary caregivers focusing on quality of life supported a recommendation for further research that would analyze the impact of that intervention on a child’s overall function. Both Sterba.

The number of class volunteers who responded to the invitation to participate in the study’s focus group was disappointing. which may have predisposed them to expect positive outcomes in such activities. or they could be reluctant to share any negative attitudes that would reflect poorly on the riding facility. but could possibly be explained by the fact that confidentiality issues preclude them from knowing the diagnosis of clients they assist. The researcher’s academic interest in both animal-assisted therapies and effective community interventions that contribute to optimally functional health coupled with experience as an equine professional and therapeutic riding program volunteer encouraged a focus on this topic of research. Clients in this study who were enrolled at CKRH varied considerably in age and length of therapeutic riding experience. appropriate interventions for children with ASD should include an emphasis on social and daily living skills. They may feel less knowledgeable and less able to contribute valid information than the instructors. As previously discussed in Chapter Two. language and 271 . however.reviewed support for this type of treatment is nearly non-existent. a qualitative approach was selected to elicit a more in-depth. Realizing those typical sample limitations would also influence the current study. Inherently small sample sizes and heterogeneous populations have plagued many previous quantitative studies in this area. The family members who were interviewed were very proactive in seeking appropriate interventions for their children. and most participated in other interventions that could also present confounding variables to the assessment of benefits received from therapeutic riding. lived experience perspective and a greater amount of data involving previously-unexplored variables that could potentially generate a broader foundation for future examination.

& Scahill (2007). and psychological functioning and in nearly all recommended therapeutic categories as well. social. and communication. Therapies should be structured to improve attention. family life. Improvement in cognitive skills such as sensory processing. and the community while minimizing core features of autism spectrum disorder (Myers & Johnson. 2001. reciprocal interaction. no matter what the level of cognitive or language abilities (Ruble. Gains in core strength. attention. White. physical. and reduction of maladaptive behaviors (Myers & Johnson. play and leisure skills. focus. National Research Council. enjoyable environment that intersperses new skill acquisition with prior-mastered skills while reinforcing positive behaviors (White et al. engagement. balance and flexibility were 272 . 2001). and the ability to follow directions as well as increased social interaction and relationship-building support the findings of Bass.communication. Results also generated an emergent theme involving benefits afforded to family members beyond those provided to the children enrolled in the therapeutic riding program. The acquisition of organizational skills such as following directions and task completion coupled with the ability to respond to appropriate motivational strategies can help prepare the child for classroom success (National Research Council. 2001). 2007). Interventions should place particular emphasis on the profound deficits in social reciprocity skills that are the main source of impairment for those affected. The data from this study reported a wide variety of perceived gains across all targeted domains of cognitive. 2007. 2006). The primary goals of therapy are to maximize the child’s ultimate functional independence and quality of life in the realms of education. and should encourage social motivation and foster self-awareness and self-esteem in a nurturing.. Keonig. academic achievement. Duchowny and Llabre (2009).

regardless of their age. Other reported benefits of notable interest that address core limitations of ASD included modification of inappropriate and self-stimulating behaviors. as one instructor suggested. Winchester et al. expanded use of language.. Clients differed as to the type of benefits received. although the children seem attracted to the animal for a variety of reasons. or their comparative location on the hypothetical autism spectrum. none of which have been previously described in the literature for therapeutic riding. or is it the combined force of horse and competent humans that enable such apparent successes to take place? The presence of the horse introduces a powerful motivational factor. (1995). Some children seem drawn to sensory factors such as the horse’s movement or the deep pressure experienced while sitting in the saddle. while others may enjoy the opportunity to interact with a nonjudgmental entity. “…there’s a lot in common that our students actually have with our horses…the way they’re treated. (2002). (2004). and Cherng et al. (2002). sex. duration of participation in the riding program. but all profited in some way: No negative comments were reported. and gross motor function improvements demonstrated by Sterba et al. motivation to participate in a therapeutic intervention. the way they’re trained…The way some people 273 . What core features of this intervention are responsible for this phenomenon? Is it the presence of the horse alone.reflective of the qualitative data reported by MacKinnon et al. Perhaps there are intangible connections that are difficult to identify. which suggests the degree to which their symptoms restrict the ability to function effectively. The most striking feature presented by the data is the therapeutic riding program’s ability to provide assistance in some measure to all participants. progress in toilet training. and the calming effect elicited by the horse.

Or perhaps the child simply enjoys the fun of bouncing along in the saddle when the horse moves at a faster pace. he doesn’t assume that he doesn’t know what he’s doing. the clients are motivated to willingly participate in a human-guided intervention that complements their co-existing treatments in a novel.is truly unmatched in size. but the horse -. Duchowny. and sensory-laden environment. experienced horse persons might be inherently well-suited to dealing effectively with children with ASD. 2009). “and the horse doesn’t have any of that…that horse…doesn’t assume that he can’t do it. & Llabre. Perhaps there is simply a combination of factors that are impossible to clearly delineate. he doesn’t assume that he doesn’t understand…The horse doesn’t know that they have limitations. behavior.” Perhaps the child with ASD senses that people often have preconceived opinions about his abilities and capabilities.think horses can’t learn…or they don’t remember…or they’re not intelligent…Or they’re all the same.” Perhaps the child associates the presence of the horse with an awareness of increased personal control or rewarding relationships. supportive. 274 . There is some precedent for the use of animal-assisted therapy in general for children with ASD (Bass.when used as an intervention incentive -. Whatever the mechanism. non-competitive.” A theory generated during the instructor focus group suggested that. sensory stimulation. “…if they weren’t so friendly and so happy and so willing to help…I don’t think the kids would get as much out of it…they make the program…the whole team makes the experience what it is. Interviewees stressed the importance of coupling the horseback riding experience with the positive attitude of the instructors and volunteers. as people accustomed to successful interaction with the nonverbal horse. and effect of movement.

the physical part of it…It’s just like the whole package and you get it all. Without the humans. with a bonus of benefits extending to family members as well. Without the horse.Many caregivers credited the total package concept with creating such positive results. In this program. “…it’s not like it’s therapy…the clinical part is taken out… so it’s just the total package…the best that you can roll into a possible situation for therapy…It’s better than what you can ever do in a room…doing…OT or PT. allowing appropriate strategies to effect a wide range of potential beneficial changes in the client. improved cognitive processing and strengthened self-concept. there is no structured intervention. “…it’s…the social and emotional part of it. Can the skills attained in the therapeutic riding environment be transferred to other situations? The caregivers say they can. “…this program is…terrific because it gives him an opportunity to try to apply some things that he’s working on very specifically in speech and in OT and in PT and it just kind of pulls that all together.” “And it gets the child more involved. 275 . greater social interaction. children more willingly participate in exercises and activities that are often quite similar to other interventions that do not equally command their interest. including behavior modification. The horse serves as the catalyst that encourages a significant treatment effect in the child. the horse leads the child to the therapy. I really believe that it’s more significant if they’re getting therapy they don’t realize is therapy a lot of times.” or. his mere presence alone does not insure results. there is less enthusiastic participation.” While the horse contributes a crucial ingredient to this intervention.” Because of the increased motivation. increased physicality. stressing that this type of intervention addresses a wide variety of common goals for children with ASD.

Suggestions and recommendations are often gained simply by word of mouth from other parents or caregivers of children with ASD. Family members in the current study often reported a lack of readily available information or professional guidance in their search for effective treatments for their children. and occupational. The establishment of networks that could assemble and disseminate such information should include public and private schools. local health departments. the therapeutic riding facility should acknowledge and promote the informal family support mechanisms that are built into the program. As the number of children diagnosed with ASD continue to rise with no identified causative agent. although it did include all children diagnosed with ASD that were currently enrolled at CKRH. The sample size in the current study is relatively small.Recommendations Through Healthy People 2010. A need for increased awareness of viable community-based programs such as the CKRH therapeutic riding program that address a wide range of symptoms for this population is apparent. and every other facility offering similar programs would differ in lesson structure and the 276 . and concurrent therapies and medications all make the findings difficult to generalize to other populations. And as this study highlighted the program’s unexpected yet significant contributions of social support and networking opportunities for family members. length of time in the program. physical. Differing ages. and speech and language therapy centers. the necessity to address this population in particular is obvious. severity of symptoms. health promotion professionals have been charged with providing increasing numbers of appropriate community interventions for youth with disabilities that can contribute to achieving and sustaining a level of physical and mental wellness that encourages a fullness of life.

The researcher was actually surprised to receive comments from the family members that were quite similar to those reported by the riding instructors and class volunteers who would share the same potential bias as the researcher. However. The children in this sample also have the advantage of having very progressive parents and caregivers who take the initiative to locate appropriate therapies and medical treatment. they were not typically familiar with horses and riding. and often had indistinct or even dubious outcome expectations upon enrollment in the program. despite the broad representation of symptoms and stated therapeutic goals in this sample. a greater level of standardization would be found in similar equine programs recognized by the North American Riding for the Handicapped Association (NARHA). 277 . the data from this study provide a number of suggested avenues for future analysis. positive gains were reported for every child. However. As was anticipated in the qualitative research design. Even though family members interviewed were actively seeking useful interventions for their children. Every effort was made to remain objective and not influence responses to guiding questions during interview sessions. The researcher no doubt brought a personal bias to the study due to previous experience volunteering in the CKRH program as well as being a career horse person. but these factors were also advantageous towards understanding and correctly interpreting the comments of the participants. which would not be the case for all children with ASD. the gold standard for rigorous evaluation and certification of facilities and instructors in this field.experience and capabilities of its personnel. Further research on the effects of the movement of the horse and what was referred to as the deep pressure sensory experiences provided by the animal on cognitive and sensory processing.

Quantitative studies with larger numbers of participants more closely matched in demographics and length of therapeutic riding experience that would measure specific cognitive. psychological. The effects of volunteer participation in such programs as well as caregiver stress and coping mechanisms for family members of children with ASD could also prove valuable. and social variables not previously studied but revealed in this data are also recommended. Study designs that could isolate the variable of the horse’s presence could also prove useful in further clarifying the nature of the animal’s role in similar interventions.emotional regulation. and toilet training of the child with ASD would seem most vital. Copyright © Margaret Ann Stickney 2010 278 .

specifically-listed records such as client registration forms containing medical information. This qualitative study will utilize multiple methods to gain an in-depth perspective on the perceived benefits of a therapeutic riding program for subjects presenting primarily with autistic disorder. The class volunteers will be asked to provide feedback on general comments solicited during the previous parent interviews. A second focus group will be conducted with 4-6 class session volunteers who work with autistic populations in the CKRH therapeutic riding program. After compilation of data from the instructor focus group and revision of the initial proposed list of guiding questions. emotional. or at a time and location convenient to the interviewees. With parental permission from the initial consent form. initial client evaluation forms. a written questionnaire will be provided for the instructor to complete for each client included in the study. a focus group will be conducted with 4-6 of the volunteer instructors from the Central Kentucky Riding for Hope (CKRH) therapeutic riding program. brief questionnaires will be administered to the instructors of children whose parents have been interviewed to request their assessment of performance and therapy goals achieved by each of these riders during the session. with particular focus on benefits that are not being measured with standardized instruments. Two interviews will be conducted with current CKRH staff members and 15 interviews will be conducted with parents of program clients. psychological. semi-structured personal interviews up to one hour in length will be conducted with CKRH staff members and parents of children diagnosed with an autistic disorder who have been enrolled in a therapeutic riding session at CKRH. and social benefits provided to these students and the multiple factors involved in this process. If a personal interview is not possible. Margi Stickney Doctoral Candidate University of Kentucky Department of Kinesiology and Health Promotion 279 . Interviews will be scheduled at the CKRH facility during therapeutic riding class times. This interactive group session will provide both an initial overview of the therapeutic riding program for autistic populations and a sampling of the instructors’ opinions on the perceived physical. and social health of this population. but that can potentially help maximize the physical. instructor lesson plans and instructor session notes will be provided by CKRH to the investigator as needed. Initially. client attendance records.Appendix A CKRH Therapeutic Riding Program Research Statement The purpose of this qualitative study is to examine the perceived benefits of a therapeutic riding program intervention for children with autistic spectrum disorders. Following the fall 2008 riding session. These records will afford an additional source for objective data collection.

where a light meal such as pizza and drinks will be provided. or by email. and social benefits can be provided through a therapeutic riding program for children diagnosed with these conditions. Every effort will be made to recruit volunteers who have worked directly with the children whose parents will be participating in the research study. you will also be asked to complete a brief oral or written questionnaire concerning the performance of any children you have instructed whose parents have been interviewed for this study. Verbal recruitment will consist of this information: I am conducting a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders. This meeting will be held at the CKRH facility. If you are interested in participating. At the end of the fall riding session. CKRH staff will supply the researcher with a contact list of names of all their instructors who fit this description. by phone. The discussion will be tape recorded. I will provide a written consent form for you to fill out prior to the focus group meeting. Instructors who participate in the focus group will also receive a gas card valued at $25. If you choose to participate. I will ask several questions to the group to help stimulate interactive discussion concerning the experiences of autistic children in the CKRH therapeutic riding program. I hope to learn what kinds of physical. 280 . They will be selected on the basis of their length of experience working with children diagnosed with autistic spectrum disorders. you will take part in a one-time focus group of 4-6 CKRH instructors who work with autistic children. psychological. and a research assistant may also be present to take handwritten notes. As group facilitator.00. and their availability.Appendix B Recruitment Documents CKRH INSTRUCTOR RECRUITMENT CKRH instructors will be recruited for the study via personal contact: in person. Your participation in this study would help provide valuable insights into the phenomena of the therapeutic riding experience for this population due to your experience teaching children diagnosed with autistic spectrum disorders.

and instructor lesson plans and session notes. and social benefits affecting overall health status can be provided by a therapeutic riding program for children with autistic spectrum disorders. or at a time and location more convenient to you. please just read and sign the enclosed Informed Consent form and return it to me in the enclosed. She is being guided in this research by her faculty advisor. If you choose to take part in this study. postage-paid envelope. but if you do choose to participate in this study. Thank you in advance for considering this opportunity to assist in this study. If you wish to join this study. psychological.PARENT RECRUITMENT LETTER Dear CKRH Parent: You are being invited to participate in a research study about the benefits of therapeutic riding for children diagnosed with autistic spectrum disorders. registration forms containing medical information. initial evaluation forms. you may reach me at 278-2693. The person in charge of this study is Margi Stickney. The researcher will ask you several questions to help you to describe in detail the types of benefits you feel your child gains through participation in the therapeutic riding program at CKRH. we hope to learn what kinds of physical. Department of Kinesiology and Health Promotion University of Kentucky 281 . you will be one of approximately 15 other parents personally interviewed by the researcher for a single session up to one hour in length during one of your child’s scheduled riding sessions at Central Kentucky Riding for Hope. You are under no obligation whatsoever. If you have any questions. By doing this study. or Dr. You will also be asked to grant access to the investigator for the following CKRH records pertaining to your child: attendance records. Margi Stickney. we feel your insights and experience with your child’s therapeutic riding experience will be an invaluable aid to furthering our understanding in this area. I will then be contacting you to schedule an appropriate interview time. M. Richard Riggs at 257-3645. Sincerely. Dr.S. Richard Riggs. a candidate for a doctoral degree in the University of Kentucky’s Department of Kinesiology and Health Promotion.

If you choose to participate. Dr. Richard Riggs. I will ask you several questions to help you to describe in detail the types of benefits you feel children diagnosed with autistic spectrum disorders gain through participation in the therapeutic riding program at CKRH. I will provide a written consent form for you to fill out prior to the interview. at 257-3645. you may contact my faculty advisor. you will be personally interviewed by me at CKRH for a single session up to one hour in length at a time convenient for you. Your participation in this study would help provide valuable insights into the phenomena of the therapeutic riding experience for this population due to your experience with children diagnosed with autistic spectrum disorders. 282 . If you have any further questions about the project. psychological. I hope to learn what kinds of physical.CKRH STAFF MEMBER RECRUITMENT Two CKRH staff members will be recruited for the study in person. If you are interested in participating. They will be selected on the basis of their length of time working with the CKRH therapeutic riding program and their experience with children diagnosed with autistic spectrum disorders. and social benefits can be provided through a therapeutic riding program for children diagnosed with these conditions. Verbal recruitment will consist of this information: I am conducting a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders.

The discussion will be tape recorded. Verbal recruitment will consist of this information: I am conducting a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders. and social benefits can be provided through a therapeutic riding program for children diagnosed with these conditions. This meeting will be held at the CKRH facility. Every effort will be made to recruit volunteers who have worked directly with the children whose parents have participated in the research study. 283 . you will take part in a one-time focus group of 4-6 CKRH volunteers who work with autistic children. and a research assistant may also be present to take handwritten notes. or by email. Volunteers who participate in the focus group will also receive a gas card valued at $25. by phone.CKRH VOLUNTEER RECRUITMENT CKRH volunteers will be recruited for the study via personal contact: in person. Your participation in this study would help provide valuable insights into the phenomena of the therapeutic riding experience for this population due to your experience working with children diagnosed with autistic spectrum disorders.00. If you are interested in participating. where a light meal such as pizza and drinks will be provided. I hope to learn what kinds of physical. psychological. I will provide a written consent form for you to sign prior to the focus group meeting. CKRH staff will supply the researcher with a contact list of names of all their volunteers who fit this description. If you choose to participate. As group facilitator. I will ask several questions to the group to help stimulate interactive discussion concerning the experiences of autistic children in the CKRH therapeutic riding program. They will be selected on the basis of their length of experience working with children diagnosed with autistic spectrum disorders.

and the second approximately half an hour. and a research assistant may also be present to take handwritten notes. and social benefits affecting overall health status can be provided by a therapeutic riding program for children with autistic spectrum disorders. and you may choose not to respond to any questions. She is being guided in this research by Dr. ARE THERE REASONS WHY YOU SHOULD NOT TAKE PART IN THIS STUDY? You may not wish to take part in the study WHERE IS THE STUDY GOING TO TAKE PLACE AND HOW LONG WILL IT LAST? The research procedures will be conducted at Central Kentucky Riding for Hope. WHAT IS THE PURPOSE OF THIS STUDY? By doing this study. The total unit of time you will be asked to volunteer for this study is one and a half hours over the next three months. There may be other people on the research team assisting at different times during the study. 284 . WHAT WILL YOU BE ASKED TO DO? You will first be a part of a focus group made up of 4-6 CKRH instructors.Appendix C Consent Forms Consent to Participate in a Research Study A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING CKRH Instructors WHY ARE YOU BEING INVITED TO TAKE PART IN THIS RESEARCH? You are being invited to take part in a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders because you are an instructor in the Central Kentucky Riding for Hope program who has experience teaching children diagnosed with these conditions. The group discussion will be tape recorded. we hope to learn what kinds of physical. You will need to come to CKRH two times during the study. WHO IS DOING THE STUDY? The person in charge of this study is Margi Stickney of the University of Kentucky Department of Kinesiology and Health Promotion. You may choose to respond to any questions you choose. Richard Riggs. The first visit will take about one hour. as well. You may also be asked to complete a brief oral or written questionnaire at the end of the fall riding session for each student you have instructed whose parent has participated in this research study. If you volunteer to take part in this study. psychological. you will be one of about 25-35 people to do so. The group facilitator will ask several questions to the group.

However. however. and to help promote this therapeutic option for other children. However. researchers have no way of ensuring that other participants will. it should be because you really want to volunteer. there are no other choices except not to take part in the study. WILL YOU RECEIVE ANY REWARDS FOR TAKING PART IN THIS STUDY? You will receive a light meal during the focus group session.00 for taking part in this study. in the future. WHAT WILL IT COST YOU TO PARTICIPATE? There are no costs associated with taking part in the study. Researchers will closely guard research information and will strongly encourage all participants to keep focus group discussions confidential. WHO WILL SEE THE INFORMATION THAT YOU GIVE? Your information will be combined with information from other people taking part in the study. some people may appreciate the opportunity to share their opinions and expertise on this subject. 285 . indeed. and a gas card valued at $25. If you do not want to be in the study. DO YOU HAVE TO TAKE PART IN THE STUDY? If you decide to take part in the study. keep this information confidential. When we write about the study to share it with other researchers. We may publish the results of this study. You will not lose any benefits or rights you would normally have if you choose not to volunteer. One possible risk would be that statements you make could be disclosed to others outside the group. we will keep your name and other identifying information private. ARE THERE OTHER CHOICES? If you would rather be interviewed separately from the group. please let the researcher know and we will make every attempt to accommodate your request. If you find that any of the questions the facilitator asks you are upsetting or stressful. help society as a whole better understand this research topic. You can stop at any time during the study and still keep the benefits and rights you had before volunteering IF YOU DON’T WANT TO TAKE PART IN THE STUDY. If you choose to participate. you may simply choose not to answer them. you should be aware that something you say in the group could be disclosed to people outside the group. we will write about the combined information we have gathered. Your willingness to take part may. You will not be personally identified in these written materials.WHAT ARE THE POSSIBLE RISKS AND DISCOMFORTS? There should be no risk or discomfort in this project. the things you will be doing have no more risk of harm than you would experience in everyday life. To the best of our knowledge. WILL YOU BENEFIT FROM TAKING PART IN THIS STUDY? There is no guarantee that you will get any benefit from taking part in this study. and we can tell you about some people who may be able to help you with these feelings.

or what that information is. We will give you a signed copy of this consent form to take with you. Audio tapes and handwritten notes from the focus group session will be stored under lock and key and then destroyed following transcription to written records. concerns. SUGGESTIONS. If you have any questions about your rights as a volunteer in this research. Margi Stickney at 278-2693. there are some circumstances in which we may have to show your information to other people. these would be people from such organizations as the University of Kentucky. please ask any questions that might come to mind now. However. suggestions. you can contact the investigator. if you have questions. _________________________________________ Signature of person agreeing to take part in the study _________________________________________ Printed name of person agreeing to take part in the study _________________________________________ ____________ Date ____________ 286 . the law may require us to show your information to a court. We will keep private all research records that identify you to the extent allowed by law. or her faculty advisor. CAN YOUR TAKING PART IN THE STUDY END EARLY? If you decide to take part in the study you still have the right to decide at any time that you no longer want to continue. Dr. WHAT IF YOU HAVE QUESTIONS. You will not be treated differently if you decide to stop taking part in the study. OR COMPLAINTS? Before you decide whether to accept this invitation to take part in the study. or complaints about the study. Later.We will make every effort to prevent anyone who is not on the research team from knowing that you gave us information. For example. we may be required to show information which identifies you to people who need to be sure we have done the research correctly. contact the staff in the Office of Research Integrity at the University of Kentucky at 859-257-9428 or toll free at 1-866-400-9428. Also. CONCERNS. Richard Riggs at 257-4635.

You have been asked to take part in this research study because you have a child enrolled in the Central Kentucky Riding for Hope therapeutic riding program who has been diagnosed with this condition. registration forms containing medical information. initial evaluation forms. WHERE IS THE STUDY GOING TO TAKE PLACE AND HOW LONG WILL IT LAST? The research procedures will be conducted at Central Kentucky Riding for Hope. The interview will be tape recorded. If you volunteer to take part in this study. or at a time and location more convenient for you. we hope to learn what kinds of physical. you will be one of about 25-35 people to do so. WHAT WILL YOU BE ASKED TO DO? You will be personally interviewed by the researcher for up to an hour during one of your child’s scheduled riding sessions at CKRH. This visit will take about one hour. She is being guided in this research by Dr. unless you prefer that it not be. and instructor lesson plans and session notes. WHO IS DOING THE STUDY? The person in charge of this study is Margi Stickney of the University of Kentucky Department of Kinesiology and Health Promotion. The researcher will ask you several questions to help you describe in detail the types of benefits you feel your child gains through participation in the therapeutic riding program at CKRH. The total unit of time you will be asked to volunteer for this study is one hour over the next three months. WHAT IS THE PURPOSE OF THIS STUDY? By doing this study.Consent to Participate in a Research Study A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING CKRH Parent WHY ARE YOU BEING INVITED TO TAKE PART IN THIS RESEARCH? You are being invited to take part in a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders. You will need to come to CKRH one time during the study. ARE THERE REASONS WHY YOU SHOULD NOT TAKE PART IN THIS STUDY? You may not wish to take part in the study. WHAT ARE THE POSSIBLE RISKS AND DISCOMFORTS? 287 . psychological. You are also being asked to grant access to the investigator for the following CKRH records pertaining to your child: attendance records. and social benefits affecting overall health status can be provided by a therapeutic riding program for children with autistic spectrum disorders. Richard Riggs. There may be other people on the research team assisting at different times during the study.

you may simply choose not to answer them. WILL YOU RECEIVE ANY REWARDS FOR TAKING PART IN THIS STUDY? You will receive tokens of appreciation such as fast food coupons and horse-related stickers for your child for taking part in this study. we may be required to show information which identifies you to people who need to be sure we have done the research correctly. However. in the future. You can stop at any time during the study and still keep the benefits and rights you had before volunteering IF YOU DON’T WANT TO TAKE PART IN THE STUDY. Audio tapes and handwritten notes from the focus group session will be stored under lock and key and then destroyed following transcription to written records. WHAT WILL IT COST YOU TO PARTICIPATE? There are no costs associated with taking part in the study. We may publish the results of this study. the things you will be doing have no more risk of harm than you would experience in everyday life.There should be no risk or discomfort in this project. some people may appreciate the opportunity to share their opinions of their child’s experiences in this program. it should be because you really want to volunteer. When we write about the study to share it with other researchers. and we can tell you about some people who may be able to help you with these feelings. 288 . We will keep private all research records that identify you to the extent allowed by law. For example. If you find that any of the questions the facilitator asks you are upsetting or stressful. To the best of our knowledge. You will not be personally identified in these written materials. we will keep your name and other identifying information private. the law may require us to show your information to a court. these would be people from such organizations as the University of Kentucky. Also. we will write about the combined information we have gathered. However. ARE THERE OTHER CHOICES? If you do not want to be in the study. Your willingness to take part may. We will make every effort to prevent anyone who is not on the research team from knowing that you gave us information. help society as a whole better understand this research topic. and to help promote this therapeutic option for other children. or what that information is. You will not lose any benefits or rights you would normally have if you choose not to volunteer. however. DO YOU HAVE TO TAKE PART IN THE STUDY? If you decide to take part in the study. WHO WILL SEE THE INFORMATION THAT YOU GIVE? Your information will be combined with information from other people taking part in the study. WILL YOU BENEFIT FROM TAKING PART IN THIS STUDY? There is no guarantee that you will get any benefit from taking part in this study. there are no other choices except not to take part in the study. there are some circumstances in which we may have to show your information to other people.

CONCERNS.CAN YOUR TAKING PART IN THE STUDY END EARLY? If you decide to take part in the study you still have the right to decide at any time that you no longer want to continue. suggestions. or complaints about the study. SUGGESTIONS. you can contact either the investigator. concerns. if you have questions. or her faculty advisor. You will not be treated differently if you decide to stop taking part in the study. please ask any questions that might come to mind now. OR COMPLAINTS? Before you decide whether to accept this invitation to take part in the study. If you have any questions about your rights as a volunteer in this research. WHAT IF YOU HAVE QUESTIONS. _________________________________________ Signature of person agreeing to take part in the study _________________________________________ Printed name of person agreeing to take part in the study _________________________________________ Name of [authorized] person obtaining informed consent ____________ Date ____________ Date 289 . Margi Stickney at 278-2693. contact the staff in the Office of Research Integrity at the University of Kentucky at 859-257-9428 or toll free at 1-866-400-9428. We will give you a signed copy of this consent form to take with you. Dr. Later. Richard Riggs at 257-3645.

The interview will be tape recorded. WHAT ARE THE POSSIBLE RISKS AND DISCOMFORTS? There should be no risk or discomfort in this project. ARE THERE REASONS WHY YOU SHOULD NOT TAKE PART IN THIS STUDY? You may not wish to take part in the study WHERE IS THE STUDY GOING TO TAKE PLACE AND HOW LONG WILL IT LAST? The research procedures will be conducted at Central Kentucky Riding for Hope. we hope to learn what kinds of physical. and social benefits affecting overall health status can be provided by a therapeutic riding program for children with autistic spectrum disorders. psychological. She is being guided in this research by Dr. you will be one of about 25-35 people to do so. the things you will be doing have no more risk of harm than you would experience in everyday life. The visit will take about one hour. WHAT WILL YOU BE ASKED TO DO? You will be interviewed by the researcher for up to an hour. WHO IS DOING THE STUDY? The person in charge of this study is Margi Stickney of the University of Kentucky Department of Kinesiology and Health Promotion. To the best of our knowledge. WHAT IS THE PURPOSE OF THIS STUDY? By doing this study. unless you prefer that it not be. There may be other people on the research team assisting at different times during the study. You will need to come to CKRH one time during the study. The total unit of time you will be asked to volunteer for this study is one hour over the next three months. you may simply 290 . If you find that any of the questions the interviewer asks you are upsetting or stressful. The researcher will ask you several questions to help you describe in detail the types of benefits you feel children with autistic spectrum disorders gain through participation in the therapeutic riding program at CKRH.Consent to Participate in a Research Study A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING CKRH Staff member WHY ARE YOU BEING INVITED TO TAKE PART IN THIS RESEARCH? You are being invited to take part in a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders because you are a staff member of Central Kentucky Riding for Hope who has had experience with many children diagnosed with autistic spectrum disorders. Richard Riggs. If you volunteer to take part in this study.

Also. and. When we write about the study to share it with other researchers. in the future. there are some circumstances in which we may have to show your information to other people. these would be people from such organizations as the University of Kentucky. WHO WILL SEE THE INFORMATION THAT YOU GIVE? Your information will be combined with information from other people taking part in the study. it should be because you really want to volunteer. However. WILL YOU RECEIVE ANY REWARDS FOR TAKING PART IN THIS STUDY? You will not receive any reward for taking part in this study. we will write about the combined information we have gathered. there are no other choices except not to take part in the study. CAN YOUR TAKING PART IN THE STUDY END EARLY? 291 . WILL YOU BENEFIT FROM TAKING PART IN THIS STUDY? There is no guarantee that you will get any benefit from taking part in this study. and to help promote this therapeutic option for other children. help society as a whole better understand this research topic. the law may require us to show your information to a court. You will not be personally identified in these written materials. We will make every effort to prevent anyone who is not on the research team from knowing that you gave us information. You will not lose any benefits or rights you would normally have if you choose not to volunteer. we will keep your name and other identifying information private. DO YOU HAVE TO TAKE PART IN THE STUDY? If you decide to take part in the study. We may publish the results of this study. WHAT WILL IT COST YOU TO PARTICIPATE? There are no costs associated with taking part in the study. Your willingness to take part may. We will keep private all research records that identify you to the extent allowed by law. we may be required to show information which identifies you to people who need to be sure we have done the research correctly. However. Audio tapes from the interview will be stored under lock and key and then destroyed following transcription to written records. You can stop at any time during the study and still keep the benefits and rights you had before volunteering IF YOU DON’T WANT TO TAKE PART IN THE STUDY.choose not to answer them. or what that information is. we can tell you about some people who may be able to help you with these feelings. ARE THERE OTHER CHOICES? If you do not want to be in the study. For example. however. some people may appreciate the opportunity to share their opinions and expertise on this subject.

We will give you a signed copy of this consent form to take with you. If you have any questions about your rights as a volunteer in this research. suggestions. Richard Riggs at 257-3645. or her faculty advisor. _________________________________________ Signature of person agreeing to take part in the study ___________ Date _________________________________________ Printed name of person agreeing to take part in the study _________________________________________ Name of [authorized] person obtaining informed consent ____________ Date 292 . if you have questions. WHAT IF YOU HAVE QUESTIONS. Dr. you can contact either the investigator. You will not be treated differently if you decide to stop taking part in the study. Margi Stickney at 278-2693. Later. CONCERNS. contact the staff in the Office of Research Integrity at the University of Kentucky at 859-257-9428 or toll free at 1-866-400-9428. or complaints about the study. please ask any questions that might come to mind now. SUGGESTIONS. OR COMPLAINTS? Before you decide whether to accept this invitation to take part in the study.If you decide to take part in the study you still have the right to decide at any time that you no longer want to continue. concerns.

You may choose to respond to any questions you choose. WHAT IS THE PURPOSE OF THIS STUDY? By doing this study. and you may choose not to respond to any questions.Consent to Participate in a Research Study A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING CKRH Volunteer WHY ARE YOU BEING INVITED TO TAKE PART IN THIS RESEARCH? You are being invited to take part in a research study about the perceived benefits of therapeutic riding for children with autistic spectrum disorders. Richard Riggs. ARE THERE REASONS WHY YOU SHOULD NOT TAKE PART IN THIS STUDY? You may not wish to take part in the study. you may simply 293 . as well. and social benefits affecting overall health status can be provided by a therapeutic riding program for children with autistic spectrum disorders. The group facilitator will ask several questions to the group. If you find that any of the questions the facilitator asks you are upsetting or stressful. the things you will be doing have no more risk of harm than you would experience in everyday life. WHO IS DOING THE STUDY? The person in charge of this study is Margi Stickney of the University of Kentucky Department of Kinesiology and Health Promotion. To the best of our knowledge. WHAT WILL YOU BE ASKED TO DO? You will be a part of a focus group made up of 4-6 CKRH volunteers. we hope to learn what kinds of physical. you will be one of about 25-35 people to do so. psychological. The total unit of time you will be asked to volunteer for this study is one hour over the next three months. She is being guided in this research by Dr. You are being asked to participate in this research study because you are a volunteer in the Central Kentucky Riding for Hope therapeutic riding program who has experience working with children diagnosed with autistic spectrum disorders. The group discussion will be tape recorded. If you volunteer to take part in this study. You will need to come to CKRH one time during the study. WHERE IS THE STUDY GOING TO TAKE PLACE AND HOW LONG WILL IT LAST? The research procedures will be conducted at Central Kentucky Riding for Hope. The visit will take about one hour. and a research assistant may also be present to take handwritten notes. There may be other people on the research team assisting at different times during the study. WHAT ARE THE POSSIBLE RISKS AND DISCOMFORTS? There should be no risk or discomfort in this project.

00 for taking part in this study. You will not be personally identified in these written materials. keep this information confidential. 294 . please let the researcher know and we will make every attempt to accommodate your request. WILL YOU RECEIVE ANY REWARDS FOR TAKING PART IN THIS STUDY? You will receive a light meal during the focus group session. help society as a whole better understand this research topic. When we write about the study to share it with other researchers. however. you should be aware that something you say in the group could be disclosed to people outside the group. or what that information is. You can stop at any time during the study and still keep the benefits and rights you had before volunteering IF YOU DON’T WANT TO TAKE PART IN THE STUDY. Researchers will closely guard research information and will strongly encourage all participants to keep focus group discussions confidential. Audio tapes and handwritten notes from the focus group session will be stored under lock and key and then destroyed following transcription to written records. we can tell you about some people who may be able to help you with these feelings. there are no other choices except not to take part in the study. If you choose to participate. We may publish the results of this study. indeed. If you do not want to be in the study. WILL YOU BENEFIT FROM TAKING PART IN THIS STUDY? There is no guarantee that you will get any benefit from taking part in this study. ARE THERE OTHER CHOICES? If you would rather be interviewed separately from the group. WHO WILL SEE THE INFORMATION THAT YOU GIVE? Your information will be combined with information from other people taking part in the study.choose not to answer them. we will write about the combined information we have gathered. and. in the future. we will keep your name and other identifying information private. However. and to help promote this therapeutic option for other children. You will not lose any benefits or rights you would normally have if you choose not to volunteer. DO YOU HAVE TO TAKE PART IN THE STUDY? If you decide to take part in the study. We will make every effort to prevent anyone who is not on the research team from knowing that you gave us information. it should be because you really want to volunteer. However. researchers have no way of ensuring that other participants will. One possible risk would be that statements you make could be disclosed to others outside the group. WHAT WILL IT COST YOU TO PARTICIPATE? There are no costs associated with taking part in the study. some people may appreciate the opportunity to share their opinions and expertise on this subject. and a gas card valued at $25. Your willingness to take part may.

We will give you a signed copy of this consent form to take with you. suggestions. there are some circumstances in which we may have to show your information to other people. For example. the law may require us to show your information to a court. CONCERNS. concerns. However. CAN YOUR TAKING PART IN THE STUDY END EARLY? If you decide to take part in the study you still have the right to decide at any time that you no longer want to continue. WHAT IF YOU HAVE QUESTIONS. we may be required to show information which identifies you to people who need to be sure we have done the research correctly. Richard Riggs at 257-3645. you can contact either the investigator. these would be people from such organizations as the University of Kentucky. if you have questions. Also. SUGGESTIONS. Later. Dr. If you have any questions about your rights as a volunteer in this research. or her faculty advisor. or complaints about the study. please ask any questions that might come to mind now. Margi Stickney at 278-2693.We will keep private all research records that identify you to the extent allowed by law. contact the staff in the Office of Research Integrity at the University of Kentucky at 859-257-9428 or toll free at 1-866-400-9428. OR COMPLAINTS? Before you decide whether to accept this invitation to take part in the study. _________________________________________ Signature of person agreeing to take part in the study _________________________________________ Printed name of person agreeing to take part in the study _________________________________________ Name of [authorized] person obtaining informed consent ____________ Date ____________ Date 295 . You will not be treated differently if you decide to stop taking part in the study.

the children and the instructors b. the children and the horses What physical improvements have you observed in the clients? Please give some examples. 9. please each write down the top 5 ways in which you personally feel autistic clients profit from therapeutic riding. What types of benefits do you think children with autism gain from the program? Give some examples of changes you have observed in these children during the course of the program? How do you think the children benefit from the horse’s presence? What types of interactions take place during a TR session between: a. How long have each of you each served as an instructor in the CKRH program? Before we start the discussion. 5. To which aspects of the therapeutic riding program do you attribute these changes in your clients? What unique opportunities are offered for these children through participation in a therapeutic riding program? 296 . the children and the other members of the class e. 10. the children and their families/friends who are watching d. 6. 4. 2. 7. What types of changes in social interaction have you observed in these clients? Please give examples. What behavioral changes in the clients have you observed? Please give some examples. 3. 8. 12. 11. What improvements in self-concept have you observed in your students? Please give examples. the children and the volunteers c.Appendix D Sample Questions for Focus Groups and Personal Interviews A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING SAMPLE PROGRAM FOCUS GROUP QUESTIONS: INSTRUCTORS 1.

semi-private. 10. 8. 16. 15. how many sessions per year? What type of class situation – private. What age and sex is the child that is participating in therapeutic riding? How long has the child participated. 12. or group? Does your child receive any other therapies during the same 8 weeks as the TR session? How does your child feel about therapeutic riding? What was your child’s initial attitude or expectations concerning TR? Have they changed? If so. 5. the other members of the class d. in what way have they changed? What were your expectations for outcomes following your child’s participation in the TR program? What has been the most positive outcome from your child’s participation the TR program? Please describe what your child does during a typical TR session. 17. 14. 11. the horse What changes in your child’s physical condition do you attribute to the TR program? What changes in your child’s behavior would you attribute to the TR program? Does your child talk to you or others about his experience in the TR program? What does your child like best about the TR experience? What does your child like least about the TR experience? Does your child look forward to attending the TR sessions? How has your child’s self-concept changed due to his experience in the TR program? What factors make this program a positive experience for your child? 297 .A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING SEMI-STRUCTURED INTERVIEW QUESTIONS: PARENTS 1. 9. 4. How does your child react and respond to: a. the class instructor b. 18. 13. 7. 3. the program volunteers c. 6. 2.

if any. 16. 4. the children and the horses What physical improvements have you observed in these clients? Please give some examples. the children and the other members of the class e. 9. the children and the instructors b. 14. 6. 8. the children and their families/friends who are watching d. What behavioral changes in these clients have you observed? Please give some examples. What aspects of the TR program do you feel are most beneficial for autistic children. the children and the volunteers c. what does therapeutic riding offer this population that other therapies or treatments do not? Give me examples of some of the changes you have observed in autistic children during your time with the program? How do you think the children benefit from the horse’s presence? What types of interactions take place during a TR session between: a. 3. 7. 5. What length of time does the average client remain in the TR program? In your opinion. How long have you worked for the CKRH program? How are clients accepted into the TR program? Is there a fee for TR services? What. 2. 11. 10. What improvements in self-concept have you observed in these clients? Please give examples What changes in social interaction have you observed in these clients? Please give examples. 15. 12.A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING SEMI-STRUCTURED INTERVIEW QUESTIONS: CKRH STAFF 1. screening processes are used for applicants? How many clients do you serve per session? Per year? What types of benefits do you think children with autism gain from the program? Describe typical expectations of parents whose children begin the TR program. 17. 13. and why? 298 .

What are your duties as volunteers? What types of benefits do you think children with autism gain from the program? Give examples of changes you observed in children with autism during the course of the program? How do you think these children benefit from the horse’s presence? How do you think the children benefit from the instructors and the volunteers? What types of interactions take place during a TR session between: a.A QUALITATIVE STUDY OF PERCEIVED BENEFITS OF THERAPEUTIC RIDING SAMPLE FOCUS GROUP QUESTIONS: CLASS VOLUNTEERS 1. 9. 2. 7. What behavioral changes in these clients have you observed? Please give some examples. What changes in social interaction in these clients have you observed? Please give some examples. 6. the children and the horses What physical improvements have you observed in these clients? Please give some examples. 11. 3. How do these children’s attitudes and participation in the class typically change from their initial experience? Tell me about some you’ve observed. the children and their families/friends who are watching d. the children and the instructors b. 10. 8. 4. the children and the volunteers c. and why you think they changed. the children and the other members of the class e. What methods or procedures used in the class do you feel are most beneficial or effective for these clients? Describe and explain why. 299 . 5.

buses. including a tendency to kick and hit the sidewalkers.Appendix E Participant Profiles The main sources of this information are the CKRH client files. and information for every client from each year of their CKRH participation was not always available. He is sensitive to loud noises. The confidential client files include forms such as the annual Participant Registration/Release. physical. appropriate communication and responses. His initial 2007 Assessment form notes difficult transitions in separation from parent/guardian and frequent anger outbursts. He has a diagnosis of autism. Lesson Request. but can follow one or two-step commands. Lesson Plan Template. He has seizures which are medically controlled. but likes trains. The facility’s standardized forms have varied over the years. Physician’s Statement and Medical History. Assessment. and speech therapies. are available to all volunteers working with clients and were also utilized by the researcher. Bob Bob is a seven year-old male who has been riding at CKRH for two years. Phone Screening. which contain no diagnoses. and Lesson Plan Checklist. and has participated in a Miracle League baseball program. with speech and major sensory issues indicated as special needs. These files may only be accessed by CKRH staff or riding instructors. He also receives occupational. and he is highly impulsive. and almost any food. The more informal Rider-at-a-Glance cards. with supplementation with data from the parent interview transcripts. 300 . Lesson goals include positive interaction with people and horses.

He had an initial diagnosis of autism and Landau-Kleffner syndrome. His problem areas include communication and speech delivery with stated goals of exercise. He uses an aid for assistance in a regular classroom at school. camping. and following multi-step instructions. but rides off-lead when possible. Rick Rick is a 13 year-old male who has been riding at CKRH for nine years. using a soft voice and slow movements when giving cues to his horse. riding independently with spotter nearby. Lesson goals include maintaining focus on 3-step tasks. with the date of onset at birth. He has a diagnosis of autism/sensory integration disorder. 301 . and cognitive. severe speech delays. increased core strength. He receives occupational therapy and has recently participated in a school bowling league as well as Boy Scouts. Dave is now riding at CKRH in a group lesson with a horse leader. verbalization. Boy Scouts. He responds to praise and likes to ride backwards. reading. balance. computers. travel. and increased independent riding. and fine/gross motor skills. swimming. with a 1996 date of onset. social interaction. Problem areas listed include receptive language difficulty. low muscle tone. Dave Dave is a 14 year-old male who has been riding at CKRH since 2003.improved beginner riding skills. He has twice participated in the CKRH Night of the Stars summer fund raiser. where he works below grade level in some areas. tactile sensation (he prefers deep pressure). and is currently riding in a group lesson with a horse leader and two sidewalkers. He lives with both parents and his listed interests have included his dog. and roller coasters. especially in the trunk.

His parents describe somewhat decreased motor planning ability. swimming. and deep pressure to meet proprioceptive needs. and enjoys riding. Jerry Jerry is a five year-old male who is in his second year of participation at CKRH. eye contact. strengthening of core muscles. and behavioral modification therapies. bowling. motor planning activities. where a diagnosis of autism spectrum disorder was determined in 2007. He sometimes pulls his eyelashes if he becomes anxious. play skills. He responds well to consistency and some sort of reward system. and is very dependent on set routines. and behavioral difficulties related to autism. emotional.learning. He currently rides in a group lesson with a horse leader and two sidewalkers. 302 . and computer activities. Riding lessons should encourage appropriate behavior and verbal responses. increased self-confidence. and developmental delays. He also participates in speech. Problem areas to be addressed include speech and communication. and changes in routine which often lead to tantrums. competitive games. father. social development. and will be riding in the Special Olympics for the first time this year. better focus and eye contact. He can be stubborn. psychological. music. Rick participates in a group riding lesson with a leader and two sidewalkers or spotters. He lives at home with his mother. attention to task. Jerry receives both speech and occupational therapy. proprioceptive difficulty. sister and dog. increased coordination. occupational. His file contained his assessment and evaluation information from the Cincinnati Children’s Hospital Medical Center.

Jim Jim is a 23 year-old male who has been riding at CKRH since he was five or six years old. Lesson goals include increasing her comfort level and confidence with the horses and the barn environment and encouraging verbalization. is afraid of dogs. low muscle tone and balance. She has limited fine motor skills and balance. Problem areas have included sensory integration dysfunction. and exhibits communication/behavior/emotional delays. He lives at home with his mother. has difficulty moderating her behavior. emotional and psychological difficulties related to Tourette’s syndrome 303 . She can become agitated easily. His earliest CKRH file records list diagnoses of pervasive developmental delay and Tourette’s syndrome. She has very poor awareness of safety-related issues. Registration forms from 2007 note diagnoses of Asperger’s and Tourette’s syndrome. and very poor confidence levels. an older brother and two nephews. She has a diagnosis of autism with a 1991 date of onset. Jim attended public school and is currently participating in a day program for adults with special needs. speech and language difficulties and communication disorders. and therefore needs to have someone in close proximity. Jan is very sensitive to sensory stimulation such as touch or loud noises. and 2008 lists diagnoses of autism and Tourette’s syndrome. typically expressing this verbally but sometimes physically.Jan Jan is a 20 year-old female high school student in her first year of participation at CKRH. tactile defensiveness. cognitive delay. although CKRH records are only available from the year 2001 on. Jan currently participates in a private riding lesson with a horse leader and two sidewalkers. with a date of onset prior to two years of age. gravitational insecurity.

He enjoys bowling. Therapeutic goals include improved trunk strength and balance. delayed toileting. increased confidence and more independent riding. Jim may communicate in short sentences with yes/no answers. cognitive processing. social delay. receptive and expressive language. increased spatial awareness. she may on occasion emit an ear-piercing scream. music. horses and horseback riding. Goals for therapeutic riding include sensory stimulation and improved integration. socialization and recreation. limited self-help skills. motor planning and fine motor skills. but does as much off lead independent riding as possible.(which improved as he matured). improved gross/fine motor skills. and acting out due to frustration with activity transitions or inability to understand verbal instructions. swimming. Meghan attends public school (in both traditional and functionally mentally disabled classrooms) and lives at home with both parents and grandparents next door. and has reported problem areas of sensory defensiveness and sensory integration problems (has a very high pain threshold). and motor planning. Meghan Meghan is a nine year-old female who has participated at CKRH since 2002. She enjoys family activities and has no fear of animals. and responds to praise and positive feedback. speech and occupational therapy. animals. and Special Olympics participation. spatial awareness. Jim rides in a group lesson with a horse leader and a sidewalker who functions as a spotter. occasional balance problems with a fear of falling and difficulty negotiating stairs. 304 . If overwhelmed with stimuli. She has an autistic spectrum disorder diagnosis with a date of onset of less than three years of age. global delay learning disability. development of new skills and problem-solving abilities. She has also participated in developmental intervention and physical.

Gary Gary is a four year-old male who is in his first session of therapeutic riding at CKRH. He has a diagnosis of autism. He was diagnosed five years ago with “very high functioning” Asperger’s syndrome. Lesson goals include increased balance and core muscle strength. Steve rides in a group lesson with a horse leader. increased socialization. but rides off-lead when possible. He has some emotional and psychological impairment due to autism and he receives speech and occupational therapy. and learning to follow 2-step directions.motor planning and coordination. increased concentration and attention span. He has some sensory sensitivity and minimal social interaction skills. He attends public school and sees a school speech therapist as well as a psychologist and psychiatrist. and depression. sensory dysfunction disorder. She responds well to visual cues and praise. and he prefers a set order and routine. and will be riding in the Special Olympics for the third time in 2008. and more independent riding. He uses a few words to communicate and follows directions fairly well. Lesson goals include 305 . He has a good sense of humor and has enjoyed participating in swimming in the past. improved language and social skills. and his problem areas include verbal and written skills. increased selfesteem and confidence. Gary rides in a group lesson with a horse leader and two sidewalkers. although he previously rode in a program in another state for three years. Steve Steve is a 16 year-old male in his first year at CKRH. successfully following multi-step directions. Meghan rides in a group lesson with a horse leader and one sidewalker. but rides off-lead as much as possible. with a date of onset at birth.

balance. constipation. His mother and two aunts share caretaking responsibilities. and behavioral difficulties. John will ride in a private lesson with a horse leader and one or two sidewalkers. and autism-related learning disabilities and emotional. age-appropriate communication. He has ageappropriate communication skills and may have difficulty with transitions if not 306 . as John recognizes a few signed words. and will self-stimulate by slapping himself in the stomach repeatedly. John John is a six year-old male in his second year of participation at CKRH. and he will be riding in the Special Olympics this year for the first time. concentration. or overstimulation may be displayed in aggression such as pinching. He will often wander or run away if not watched carefully. coordination. His reaction to fear. and gross motor planning skills.improved balance. thought control disorder. He receives speech and occupational therapy and sees a psychologist. Wayne Wayne is an eight year-old male who has been riding at CKRH for two years. He enjoys grooming and spending time bonding with his horse. coordination. successfully following multi-step directions. increased focus on task. frustration. and improved independent riding skills. He likes animals but would not touch them in the past. balance. strength. He has a diagnosis of autism with related behavior problems such as tantrums. motor planning. He was diagnosed with autism at 18 months and was non-verbal when he entered the program in 2007. low muscle tone and endurance. Problem areas include tactile issues. although he often emits high-pitched screams or squeals. Lesson goals include improved verbalization. A communication board (for visual aids) and sign language may be employed. psychological. and coordination.

and is fascinated with numbers. and behavioral issues. speech. His problem areas include sensation and tactile awareness. He also participates in Miracle League baseball and receives speech and occupational therapy. motor planning. and learning to follow multiple-step directions from instructors. two sisters. increased muscle. and interaction with peers. he had no spontaneous language and he is subject to frequent screaming and tantrums. proprioception and coordination. sensory input. and emotional. as well as applied behavior analysis. Doug Doug is a nine year-old male who has been riding at CKRH since 2002. Wayne rides in a group class with a horse leader and two sidewalkers. Wayne lives at home with both parents. brother (who has Asperger’s syndrome) and family dog. dates and calendars. He enjoys swimming. 307 . fine/gross motor skills. following twostep instructions. and an autism assistance dog named Snoopy. and social skills. muscle strength. and motor planning. lack of confidence. Doug attends public school and lives with his mother. Riding lesson goals include improved verbalization and vocabulary. thinking and cognition (thought control disorder). balance. Goals for his riding lessons include improved fine/gross motor skills. communication. When he began participating. core strength (especially in hands). He receives occupational. Doug rides in a group lesson with a horse leader and two sidewalkers. His diagnosis is autism with an age of onset of two years. less hand flapping behavior. balance. psychological.adequately prepared. selfconfidence. and physical therapy. core strength. loves Charlie Brown (which he likes to be called). sister.

thinking and cognition. with reported problem areas of speech. who also rides at CKRH. sensory integration. Kerry Kerry is an eight year-old male who has ridden at CKRH for three years. sensory work. where he hopes to compete for the third time this year. He has diagnosis of Asperger’s syndrome. balance and coordination. but rides off-lead as much as possible. communication. Brian has previously participated in the CKRH summer fund raiser Night of the Stars and has won a gold medal riding in the Special Olympics. appropriate conversation and social interactions. His cognitive function is above the norm for his age group. motor planning and problem-solving skills. balance. and behavioral issues (such as repetitive motions) related to his diagnosis. proprioception. minor balance and coordination. Lesson goals have included increased confidence and independence. Brian attends public school and lives at home with his mother. Problem areas have been listed in tactile sensation. He attends private school. 308 . and emotional. Brian rides in a group lesson with a horse leader and one sidewalker functioning as a spotter. psychological. tactile sensation.Brian Brian is an 11 year-old male with a diagnosis of Asperger’s syndrome who has been riding at CKRH for seven or eight years. Riding lesson goals include increased core and upper arm strength. improved muscle strength. and body control. thought control disorder. and he tends to be very talkative. uncontrollable repetitive movement. motor planning. and to improve interactions between Brian and his brother. balance. brother (who has autism) and sister. and has received occupational and speech therapy.

He gets bored easily and needs constant challenge and activity. where he rides with a horse leader and two sidewalkers. coordination. a sister and three dogs. Lesson goals include increased attention span and focus on task. Fear or insecurity may bring on a “meltdown. He has a diagnosis of autism and hypotonia. with concerns in balance. and improved balance. strength. Robin began riding in private lessons but progressed on to a group class. and fine/gross motor skills. This year he participated in the CKRH summer fundraiser. coordination. Night of the Stars. coordination. 309 . as well as independent riding skills and the ability to follow multi-step directions. completing multi-step directions. proprioceptive awareness.” but deep pressure is often helpful in calming him. motor planning and riding skills. with delays in speech and socialization. He receives physical. Kerry rides in a group lesson with a horse leader and one sidewalker acting as a “spotter. strength. stability.motor planning. Robin Robin is a five year-old male who has ridden at CKRH for the past two years. tactile defensiveness.” but rides off-lead when possible. sensory processing. He attends pre-school and lives at home with both parents. and he thinks he would like to become a jockey. speech language and occupational therapy. and motor planning.

Appendix F CKRH Record Forms 310 1 .

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Kentucky Horse Park Adjunct Instructor Kentucky Community and Technical College System. 1952 Springfield.A. Bluegrass Campus HONORS None PROFESSIONAL PUBLICATIONS None _________________________________ MARGARET ANN STICKNEY 327 . Speech/Theatre Education Otterbein College July 11.. Ohio 1974 PROFESSIONAL POSITIONS 1990-2007 2003-2006 Director of Education.VITA DATE OF BIRTH PLACE OF BIRTH EDUCATION 1979 Elementary Education certification and Minor in Horsemanship Morehead State University B.

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